Better sterile than dead: How trans activists justify destroying the fertility of minor children

Note: All screenshots in this post are from publicly accessible websites.

Update 4/4/16: Lisa Toinen Mullin, whose comments on the WPATH Facebook page were featured in this post, has responded in the comments below. Please see the 4thWaveNow response here.

Update 4/1/16: How do the gender specialists and trans activists square their cavalier promotion of “trans-kid” sterilization with this: Many trans men have a fervent desire to be biological parents. By all indications, these people treasure their fertility. There are apparently so many of them that there’s a whole movement afoot to cleanse the language of birthing and reproduction of any trace of femaleness, in order not to offend trans men. For example, midwives are now admonished to say “pregnant person” instead of pregnant woman. And “vagina” and “breastfeeding” may be triggering, so must be replaced by “front hole” and “chest feeding,” respectively.

What say you, activists and pediatric transition promoters? Why would you want to deny trans kids the same opportunity to procreate that many trans men have?


I’m sure some of my regular readers must get tired of the constant reminder that puberty blockers followed by cross sex hormones results in permanent sterilization of preadolescent children. Many would probably call what I do harping. Why do I include this point in nearly every post I write?

Is it because I think every (or even most) trans-identified kids will grow up to want to be biological parents? Am I a proponent of replenishing the already overtaxed planet via endless childbearing? Am I biased in favor of reproduction because I am myself a parent?

Nope. It’s pretty damn simple. I just happen to hold the view, seen once-upon-a-time as a matter of common sense and ethics, that healthy minors should not be sterilized for any reason. That no adult has the right to sterilize a minor. That the capacity to bear offspring is a basic human right, and that a child’s reproductive capacity should be guarded by responsible adults against anyone who would even think about taking that right away before adulthood. That, by definition, no child or teenager can predict whether they’ll want to bear children later in life. (Having children is pretty much the last thing on the mind of tweens and teens—for good reason. How many 10 or 12 or 14 or even 20-year-olds have any concept of what that choice would mean?)

Duh?

But not sterilizing kids is no longer a “duh” to journalists who write parrot trans activist talking points about “trans kids.” In fact, evidently some global uber-editor has decreed that this side effect of pediatric medical transition is so unimportant, is so worth it, that it doesn’t even merit a media mention. Very rarely do I see even a sentence acknowledging the guaranteed future sterility of trans kids who have followed the typical path from blockers to hormones. And I have never seen a mainstream journalist take up the issue as a moral conundrum, something to investigate in more depth.

So as long as the New York Times, the Washington Post, the Guardian, and the rest of the Fourth Estate (more like, the Fifth Column) continue to ignore that kids are being sterilized, this obscure blogger is going to keep drawing attention to that fact.

You’d think at least a scientific journal would deem child sterilization a worthy subject to discuss. But no. Even the venerable Nature, one of the most highly respected journals in science, which recently published a much-shared piece about new NIH-funded research on adolescent guinea pigs trans teens, says NOT ONE WORD about sterilized kids.

Very likely no one touches this topic because, well, it’s kind of a taboo. It’s a dirty little secret that trans activists would rather the general public not think too hard about. I mean, most sane people would raise a question or two about the wisdom of sterilizing kids.  (In my personal experience, there are two ways to get good liberals to do some critical thinking about trans issues: mention child sterilization or the fact that most gay/lesbian people don’t even fully realize and claim their orientation until their early 20s, long after medical transition commences.) After all, it’s even controversial (and, ahem, worth writing an article about) to talk about sterilizing severely disabled children. It’s even difficult for young adult women in their 20s or older to get their tubes tied.

The aforementioned Nature article is currently being discussed on the public WPATH Facebook page, and to my surprise, and to their credit, a couple of pro-trans clinicians actually put forward the fertility question as a troublesome aspect not covered in the article.

rixt

Who can argue with this simple declaration?  But as we’ve seen, activists and gender specialists are very eager to push the age for medical treatments lower and lower—be it “top surgery” for trans boys or genital surgery for trans girls. Why bother with the blockers at all, if (contrary to any evidence) little kids know they’re trans from the get-go? And sterilization? Nothing more than a “strawman” according to one trans activist:

LisaM strawman

Oh, pshaw. Only “cis” heterosexuals concern themselves with silly things like “protecting fertility”–in children.  And anyway. LGBT adults tend to have fewer kids, so we’re safe to assume these trans kids probably won’t, either.

lisam gay lesbian

Two concerned clinicians seem to recognize who’s really propping up a straw man here:

Rixt Arlene.jpg

Rixt Arlene part 2.jpg

She says it: “I do not think teenagers can really understand what this loss may mean to them.” Not only that. She points out another little detail that isn’t discussed in the mainstream media: Children who go from blockers to cross sex hormones can never develop mature gametes–that is, it will be impossible for these people to ever produce their own biological children, because their body’s capacity to generate sperm and eggs will have been forever curtailed.

Bravo, clinicians. Even though you are enabling these kids to forfeit their future fertility (despite your admitting there may be problems in “30 or 40 years”), it’s good to see someone standing up for the reproductive rights not only of “trans” kids, but also gay and lesbian parents.

But the activists (whose only claim to authority is their own transgender status) are unswayed in their fervor to promote sterilization of other people’s children.

LisaM cisnormative

Although society recognizes that minors don’t have the cognitive wherewithal to vote, drink, sign contracts, or even use tanning beds safely, it’s simply “cisnormative logic” to be concerned that they might not fully understand what it means to be irreversibly sterilized at 14.

And what argument by a trans activist would be complete without reference to the transition or suicide!!! meme (despite no evidence that transition is the cure for self harm in teenagers, and despite the constant misuse of the 41% suicidality figure by activists and a prostrate media)?

better sterilie than dead.jpg

Better sterile than dead. The adult trans activists have spoken. Other people’s minor children are “trans people” who will absolutely choose suicide over their future fertility.

Listen to your trans elders, kids, and ignore any doubts voiced by your parents. Statistics show that you’re less likely to want kids anyway when you grow up, and if you do? The Brave New World of medical technology will fix you up.

Not that you teens are the least bit interested in talking about having kids anyway. Childbearing? Who thinks about that? If anything, you’d be more interested in hearing about the latest advances in neovaginas or phalloplasty technology. And while you’re waiting for your genital surgery,  discreet panties with a “thick cotton crotch insert to mask the genitals” and teeny bopper packers can tide you over.

The infallibility of the oppressed: Story of one influential trans activist

by Overwhelmed

I recently came across this well-written article from a former social justice activist. It reveals how people with good intentions try to change the world for the better, but can end up doing just the opposite. Here are some quotes from the essay that I thought were particularly relevant:

 “I need to tell people what was wrong with the activism I was engaged in, and why I bailed out.

This particular brand of politics begins with good intentions and noble causes, but metastasizes into a nightmare. In general, the activists involved are the nicest, most conscientious people you could hope to know.”

“There is something dark and vaguely cultish about this particular brand of politics. I’ve thought a lot about what exactly that is. I’ve pinned down four core features that make it so disturbing: dogmatism, groupthink, a crusader mentality, and anti-intellectualism.”

“Perhaps the most deeply held tenet of a certain version of anti-oppressive politics – which is by no means the only version – is that members of an oppressed group are infallible in what they say about the oppression faced by that group. This tenet stems from the wise rule of thumb that marginalized groups must be allowed to speak for themselves. But it takes that rule of thumb to an unwieldy extreme.”

“Consider otherkin, people who believe they are literally animals or magical creatures and who use the concepts and language of anti-oppressive politics to talk about themselves. I have no problem drawing my own conclusions about the lived experience of otherkin. Nobody is literally a honeybee or a dragon. We have to assess claims about oppression based on more than just what people say about themselves. If I took the idea of the infallibility of the oppressed seriously, I would have to trust that dragons exist. That is why it’s such an unreliable guide. (I half-expect the response, ‘Check your human privilege!’)”

I believe that many trans activists have good intentions when it comes to gender-defying kids. I think they feel noble, that they are rescuing children from inevitable doom. Since these crusaders are transgender themselves, they label themselves experts and, along with their social justice allies, conclude they know best. When someone questions their cause, they easily discount any concerns as “transphobic.” They are so focused on doing good, they are blind to the negative consequences of their campaign.

One of these likely well-intentioned activists is Aidan Key, who appears to believe that the lives of transgender children are at stake if not affirmed as the opposite sex. Key seems particularly driven to educate the public, believing that stamping out ignorance will remove the reluctance of people to accommodate these kids.

aidan-4

Aidan Key

(Before I continue, I want you to be aware that I believe no one can actually change sex, just their outward appearance. But for this post I will be referring to Aidan Key using preferred pronouns as a courtesy. I am not out to brazenly offend anyone and would actually welcome constructive dialogue on this subject.)

Who is Aidan Key? He was born female (and originally named Bonnie) but started transitioning to male in his thirties. A self-proclaimed Gender Specialist, Key has a BA in Communication, Program Development, but he counts psychotherapy and mental health counseling among his skills.

Key CV

Key has worked tirelessly to bring awareness to the public that transgender children are a normal variation. He states that these kids don’t need to change their gender expressions or identities. Instead it is society that needs to change by accepting and affirming them as their authentic selves.

 The truth of the matter is that having a transgender child is an inconvenience to society because, instead of asking the child to change, we are asking society to change. This is a tall order.

Even though Key realizes that changing the world is a “tall order,” it hasn’t stopped him from trying. For over a decade, he has been involved in many different projects, attacking what he considers ignorance from all angles.

In 2005, Aidan and his identical twin sister Brenda were featured on an Oprah Winfrey Show titled “Transgendered Twins.”

 But early on, there was one major difference—Brenda was “the lady” and Bonnie was “the tomboy.” Bonnie hated wearing dresses. When playing house, she preferred to take the role of dad because she just didn’t feel like a girl. With puberty, the twins had trouble relating at all. “I got as boy crazy as I think you could get,” Brenda says. “I’d look at Bonnie and see her be so calm and levelheaded around these boys. [I’d think], ‘How does she do that?'”

During college Bonnie realized that she was a lesbian. Right away she came out to her twin sister. “She told me she had an encounter with a woman and kissed her,” Brenda says. “I got really upset about it because we’re twins. We’re supposed to be identical.”

For the next 15 years, Bonnie lived as a lesbian, married a woman and even adopted a daughter. But once again she began to feel that things were still not right. When she met two men who had transitioned from female to male, Bonnie felt a connection. She made the most difficult choice of her life—she decided to become a man.

(As has been talked about many times on 4thWaveNow, so many trans men formerly lived as  lesbians—but no one in the media ever really delves into why these women abandon their femaleness.)

Prior to this interview with Oprah, though, Key was already becoming well known in the transgender community of Seattle, Washington. In 1999, he founded the Gender Diversity Education and Support Services. And in 2001, he launched the first Gender Odyssey conference.

Gender Diversity,  a non-profit, has the goal of increasing awareness and understanding for gender diverse individuals of all ages. The organization facilitates many support groups for families with gender-variant children. And training sessions for workplaces, health providers and K-12 public and private schools are offered. The following is information about their school trainings.

Increased awareness and education regarding gender identity enables all children to achieve a more holistic and confident school experience. Our aim is to not only assist a school in the optimal inclusion of transgender students, but to highlight the ways that creating a more inclusive environment benefits all students.

Scheduling a training or consultation with Gender Diversity will help you…

  • Understand, adhere and fully implement a school’s anti-discrimination and inclusion policies
  • More fully incorporate the topic of gender within the school’s existing diversity programs and commitments
  • Support a transgender student through a gender transition
  • Increase the school community’s understanding of gender identity and expression as it relates to all students
  • Seek specific guidance relating to gender-segregated spaces such as bathrooms, locker rooms, sports and other team activities
  • Adequately and confidently answer questions from parents or other students
  • With one-on-one lesson planning or problem-solving with a teacher, staff or administrator
  • Develop age-appropriate classroom instruction on issues related to gender and gender diverse identities and expressions

An ideal educational package includes training for all school personnel, parent education and age-appropriate gender education for students.

Gender Odyssey  is an international conference geared towards transgender and gender non-conforming teens and adults. It includes “thought-provoking workshops, discussion groups, social events and entertainment.” Conference programming for 2016 has not yet been released, but the schedule for 2015 is still on their website. Last year’s keynote speakers were Kate Bornstein and Andrea Jenkins. Over the course of three days, there were numerous workshops with a wide range of topics including, but not limited to, the impact of trans identities on relationships, how to change identity documentation, increasing awareness of anti-discrimination legislation, hormones and surgeries.

Quite a few workshops focused on medical intervention. One workshop presenter was Dr. Tony Mangubat, who regular readers will remember from 4thWaveNow’s post on a 15 year old gender dysphoric girl who had her breasts surgically removed.

Mangubat workshop

Another surgery workshop is presented in part by Dr. Curtis Crane, a doctor with “penis-making skills that have won him a global following.” Crane’s burgeoning top surgery business was discussed in this 4thWaveNow post.Crane workshop

This show-and-tell workshop, with the euphemism “chest surgery” in its headline, makes me particularly sad.

chest surgery

The annual Gender Odyssey Family conference was started by Aidan Key in 2007. It is tailored for families with gender variant children and “provides real tools to support and encourage your child’s self-discovery in regard to their gender.” Below is a small selection of workshops from the 2015 lineup.

 Some presentations, like this one, concerned social complications that arise as a result of a transgender identity.

kid with crush
The next three workshops were presented all or in part by gender specialist Johanna Olson-Kennedy, the subject of a recent 4thWaveNow post highlighting Dr. Olson-Kennedy’s desire to lower the age for genital surgeries because trans kids are being left in “limbo” after being on puberty blockers–the theme of the third workshop below.

Olson non binary.pngolson puberty suppression

Olson limboThe Gender Odyssey Professional conference, the newest in the series of conferences, first launched in 2012. It is geared toward professionals, and participants can earn Continuing Education credits.

Leading experts will offer sessions discussing best practices for therapists, legal considerations related to transgender issues, current medical protocols, and educational considerations including model policies for gender variant students ages K-12. Continuing Education and Clock Hours available.

The 2016 conference includes this workshop by Asaf Orr, which sounds like it is designed for teachers and school officials. Orr was one of the lead authors of “Schools in Transition,” a set of transgender-inclusive guidelines for schools, which I wrote about here.Orr schools

And here’s a workshop that seems to focus on the inconvenience of pesky gatekeepers.

gatekeeping

Then there’s this talk by Mara Keisling, a trans woman and founding Executive Director of the National Center for Transgender Equality. Because the trans rights movement needs even more momentum.

Keisling

School indoctrination is a big focus of trans activists, and the conference features another workshop geared toward elementary school teachers. Johanna Eager is part of the Human Rights Campaign’s Welcoming Schools project.

welcoming schools

Aidan Key has accomplished a lot with these organizations, and his activism doesn’t even come close to stopping there. Besides juggling support groups, conducting trainings and putting on conferences, he has teamed up with Kristina Olson, an assistant professor of psychology at the University of Washington, on the TransYouth Project.  You may remember 4thWaveNow’s analysis of the first study generated by the TransYouth Project here.

The TransYouth Project aims to help sci­en­tists, edu­ca­tors, par­ents, and chil­dren bet­ter under­stand the vari­eties of human gen­der devel­op­ment. Based out of the Social Cognitive Development Lab at the University of Washington, we are cur­rently leading the first large-scale, national, lon­gi­tu­di­nal study of devel­op­ment  in gen­der non­con­form­ing, trans­gen­der, and gen­der vari­ant youth . In addition to our primary goal of supporting the first major study of transgender children in the U.S., we are also conducting research about the origins of anti-transgender bias, and have plans for outreach projects in collaboration with some of our partner organizations.

Another one of Key’s many talents is writing. He authored the transgender child chapter of Trans Bodies, Trans Selves and has written blog posts for the Huffington Post and Welcoming Schools.

In addition to the Oprah Winfrey Show, he has appeared on Larry King Live, National Public Radio, Inside Edition and Nightline.

And that’s not all. Due to his “expertise,” Key has designed and helped implement policies and procedures for the rights of transgender school children in grades K-12 with the Washington Office of Superintendent of Public Instruction (OSPI), the Washington Intercollegiate Activities Association, and Seattle Public Schools.

There is still more. He is also involved in film. In 2005, Key started the annual TransLations Film Festival, which shows movies featuring transgender personalities. And, more recently he has become the Primary Consultant for the upcoming documentary “Inside Out.”

Inside Out, a 90-minute documentary, takes us deep inside the world of transgender and gender non-conforming children. Ranging in age from pre-school through high school, these children feel they were born with bodies that do not match their innate gender identity. Each yearns to live an authentic life – and live Inside Out….

In a culture that is deeply invested in gender norms, the discovery that “boys will not always be boys” has frequently led to fearful responses and an attitude of intolerance. Indeed, many view transgender rights as the next civil rights front. The stakes are high: over 40% of transgender youth attempt suicide at least once before their 20th birthday. This forces many parents to ask themselves, “Would we rather have a live daughter or a dead son?”

You would think someone as steeped in transgender research and activism as Aidan Key would know that the 41% suicide attempt figure (repeated uncritically ad nauseum in the press) is based on a faulty interpretation of the survey by the Williams Institute. 40% of trans-identified people don’t actually “attempt suicide.” In fact, gender nonconforming people (not just those who ID as trans) have more suicidal thoughts and self-harming behavior over their lifetime, and it is not at all clear that “transition” is a solution for most. But scaring parents with the worst imaginable nightmare is standard practice for trans activists, and Key is obviously no exception in using this emotional blackmail technique to quash dissent.

Why did I just enumerate the prolific accomplishments of Aidan Key? Well, I intended to convey his great influence on countless numbers of children and adults, and point out that he is only one of many trans activists doing so. These people are the drivers of the international rise in transgender-identifying youth.

GIDS increase in trans kidsOf course many activists, like Aidan Key, think this increase in trans youth is a positive thing. Here is Key on a live chat at the Seattle Times:

Seattle times

I predict that unless something drastically changes, we will be seeing many more youth like ours caught up in this trend: Kids who have been educated that being transgender is a normal variation of the human condition; that it is possible to change sex; that society needs to accommodate them; and that transitioning will solve all of their problems. These messages are especially attractive to children who have difficulty navigating the turbulent adolescent years.

Initially, the goal of trans activists may have been to make it more acceptable for boys to wear dresses and play with dolls and girls to be on soccer teams and play with trucks (which I think is a noble aim), but the activism has gotten out of hand. Now there are many confused children that are convinced that altering their bodies is the only option for happiness. And it has literally become a nightmare for many families.

I wonder at what point, if any, trans activists and their allies will start to question their crusade. I hope for the sake of our children that more of them, like the social justice warrior quoted at the beginning of this piece, wake up to the harms that their campaign is causing.

And, I hope that more people will start challenging the premises of trans activism. We need more people to realize that members of an oppressed group are not infallible. Being transgender doesn’t mean they know best. They are human like everyone else and their views should be assessed as such–not as all-knowing experts.

 

Minor surgery? Top US gender doc agitates to lower age for genital surgery

Dr. Johanna Olson-Kennedy of LA Children’s Hospital is one of the better known “gender specialists” in the United States. She has achieved notoriety amongst gender critics for her controversial advocacy of early cross-sex hormone treatment and “social transition” of young children.

Her latest efforts to push the envelope on child transition are on display in a post she made two days ago on the public WPATH Facebook page, wherein she lobbies for the next WPATH Standards of Care (SOC 8) to support lowering the age of consent for “bottom” surgery (officially recommended to be 18 or older in the WPATH SOC 7).

To date, Olson’s post has garnered 52 “likes,” with plenty of enthusiastic responses. Only one clinician has raised a shadow of doubt.

What does Dr. Olson-Kennedy want? Nothing more than for immature preadolescents to be allowed to undergo–with full insurance coverage–major genital surgeries so they can impersonate the opposite sex at an earlier age.

Olson orig post

Because of the upside-down activist-driven reality we live in today, rather than helping gender dysphoric young people come to terms with their healthy young bodies, Dr. Olson-Kennedy and her colleagues socially transition children to believe they are the opposite sex.  By “affirming” a child’s (by definition, childish)  idea that they are born in the “wrong” body, pediatric transgenderists like Olson-Kennedy condition the child to reject and even abhor their “wrong” body, thereby making natural puberty an enemy to be “blocked” at its onset—in the example Olson-Kennedy cites in her post, as early as age 11. Everyone in the child’s life is “supportive” and “affirming” of the fiction that one’s sex can be changed, so it’s not surprising that 100% (the figure cited most often by these gender specialists) of socially transitioned, puberty-blocked children desperately want to move on to full medical transition (and into the waiting arms of surgeons and endocrinologists). Carving up, sterilizing, and drugging a child’s body is becoming more and more normalized.

It’s worth noting that the WPATH Facebook page is not only frequented by doctors and psychologists. Comment threads are often dominated by trans activists, whose views are typically received as expert opinion. One such activist is trans woman Kelley Winters, a PhD. in electrical engineering who has presented to WPATH and is deferred to as an authority on matters of pediatric transition. Winters is not the only one; typically these individuals have no training in medicine or child psychology, with their only claim to authority on pushing for mutilating surgeries and hormones for other people’s children being their own transgenderism and conviction that turning other people’s children into lifelong medical patients is the right thing to do.

Winters and Olson

So Olson-Kennedy and others have created a medical condition that can only be treated by massive infusions of cross-sex hormones and surgeries. The children are blocked early, and now we have a self-fulfilling prophecy. Of course these “girls” are not going to want to stop feminizing hormones. Of course they feel their lives have been “put on hold,” and they are all going to want “functioning vaginas.” The gender specialists have quite successfully crafted a situation where these young people will long for a surgically-engineered body as young as possible. How could they not want that? And how difficult would it be to desist from these longings once the train has started down that road, with all their friends, their families, and a prostrate media cheering them on?

Just to establish (and for my regular readers, review) a few simple facts:

  • “Bottom” surgery aside, puberty blockers followed by cross sex hormones results in guaranteed lifelong sterility. This is a fact that is never disputed by any specialist, but which is downplayed and seldom mentioned by anyone. Sterilization of children in any other context would be considered a human rights abuse, not a social justice triumph.
  • There is no research or clinical evidence that gender identity is innate. On the contrary: There is decades of research showing that gender identity is a matter of identification with gender stereotypes and parental modeling. It is impossible to find a story about a “trans child” that does not include anecdotes about these children preferring typical gender-stereotyped activities, clothing, and hairstyles of the opposite sex.
  • Frontal lobe development—in particular,  sound judgment, the capacity to understand and care about future consequences, and impulse control—is not complete until the mid-20s.
  • Young brains are highly plastic. It is patently obvious that the very act of “socially transitioning” young children to believe they are “born in the wrong body”  conditions them to continue on to full medical transition, with all the attendant risks and consequences.

Olson-Kennedy’s thread is ongoing, with many enthusiastic commenters and supporters. I encourage readers to see for themselves and then inform others about what the leading lights of pediatric transition are doing and saying. This is the future for gender nonconforming children and preteens, and the public deserves to know.

Tumblr snags another girl, but her therapist-mom knows a thing or two about social contagion

Below is a comment recently submitted to 4thWaveNow by (yet another) parent of a girl who discovered the trans-trend on social media. This mom just happens to also be a psychotherapist.

Update: Please see the comments section for a lively and important discussion about the state of psychotherapy for trans-identified kids–including the controversy about what is (and isn’t) “conversion therapy.”

In a time when major professional organizations representing social workers, therapists, and school counselors are fully aboard—hell, they’re steering–the trans-kid bandwagon, it’s refreshing to hear from a therapist who hasn’t drunk the Kool-Aid.

But surely there must be many others who have doubts? Given the stunning disconnect between (on the one hand) the established knowledge about child and adolescent development in both neuroscience and psychology (things like identity formation, executive function, magical thinking, and neuroplasticity, to name only a few important lines of study), and (on the other hand) the simplistic mantra “if you say you’re trans, you are!” touted by “gender specialists,” there has to be some cognitive dissonance churning the minds of thoughtful clinicians.

We’ve heard from a few of them. In Exiles in Their Own Flesh, therapist Lane Anderson wrote that her skepticism about the transgender trend, along with her commitment to professional ethics, eventually drove her to resign her post working with trans-identified adolescents. Psychoanalyst  David Schwartz was featured in a post highlighting his insightful critique of the “inflated idea” of transgenderism.  And blogger Third Way Trans, a detransitioned man/former trans woman who is a graduate student in psychology, does yeoman’s work presenting a more nuanced view of transgenderism and identity politics.

Perhaps skepticaltherapist’s words will move a few more mental health professionals to speak up on behalf of our kids? We can hope.


by skepticaltherapist

There is an episode of Star Trek: The Next Generation where the crew is introduced to a mysterious alien video game. It slowly infiltrates the minds of the crew, and Wesley Crusher and another young ensign watch as the adults around them slip into addiction. Wesley begins to sense that something is amiss, and goes to find Captain Picard. He is so relieved to find the Captain and to be able to confide in him. As Wesley leaves, we see the Captain reach into his desk with sinister sangfroid and take out a gaming device. He too has been infected. As we suspected, the game is really an insidious mind-controlling apparatus that will allow an alien race to gain control of the ship.

star trek

That is what this trans madness feels like to me. When I first began to hear this emerging in the young people around me, I felt confused. As a dyed-in-the wool liberal, I felt I should be accepting and affirming. As a therapist and long-time student of human nature, it just doesn’t make sense to me that people are “born in wrong body” except for perhaps in extremely rare cases. I believe there are “true” cases of transsexualism, but the number of those affected must be vanishingly small. Why all of a sudden did it seem to be everywhere?

When thoughtful colleagues and friends started talking matter of factly about five- and six-year-olds who were being supported and affirmed in choosing another gender, I was stunned. How could that possibly be anything other than very confusing for a young child? What was I missing? I must, I at last concluded, be getting truly old.

The alien mind control device made its way into my home about two years ago when my then eleven-year-old daughter begged me for a Tumblr account since her friends all had one. Foolishly, I consented without looking into it further. I wish I hadn’t. This trend toward all things pan/bi/non binary/gender fluid/trans, etc. has generated a huge amount of energy among kids my daughter’s age. I had been watching it with some degree of suspicion and concern. But last month the degree of my alarm grew. She started dropping provocative hints, such as asking us if she could get a buzz cut. I found some writing she had left around the house, where she wondered to herself whether she were “really a girl.” She was very excited a few weeks ago when a new friend came out as trans.

It isn’t that I am a hating ogre. I think if I really believed that my kid were profoundly unhappy in her body, that this narrative was coming from her and not from social media and the kids around her, I would be reacting very differently. I would also have a different reaction if I could convince myself that gender identity experimentation were essentially harmless. Girls want to pretend to be boys? Sure! Why not? But it is absolutely chilling to think that, these kids who are just doing what teens do, get support from the adults around them that let them get stuck in the experiment so that many of them wind up permanently changing their bodies.

For the record, this is a kid who has never had any gender nonconforming behavior at all. She has always been a girly girl. As a toddler and young child, she had several “crushes” on boys. She has always been very consistent in having fairly typical “girl” interests, with few to no “boy” interests. She has always been interested in art and dance at school. She is a little socially anxious, and that is about the only thing that makes her susceptible to this, I think. Probing further, she admitted that she has been binding, and has asked her friends at school to call her by a gender-neutral name. She also told us that she had begun researching testosterone. Luckily, her interest in this started just a few weeks ago, as best as I can tell.

After that conversation, I was a wreck. In spite of having taken a sleep aid, I woke up at four am that night, my heart pounding out of my chest. I started googling again, as I had done before, trying to find some place on the internet not infected by either the “trans is terrific” narrative, or hateful speech from the other side. Search term after search term returned similar results. “Trans peer pressure,” for example, returns article after article about how trans kids need support against bullying and peer pressure. Finally, “social contagion trans” brought me to this site.

Such a huge, huge relief. I feel like Wesley Crusher finding the one other person on board the Enterprise whose mind hasn’t been taken over.

Her current school is a wonderfully progressive and nurturing. But the school administrators all seem keen to jump on the “trans is terrific” train. They proudly proclaim to prospective parents that there are several kids transitioning in the upper school. It seems like this fact is sort of exciting to everyone, and establishes without question their all-accepting super liberal cred.

I have decided that the cult indoctrinators have had free access to her beautiful thirteen year-old-brain for two years now, and that it is time that I intervene and fight for my daughter. I am so grateful for the clarity I have found on this site. Because of this blog and the stories shared here, I am feeling cautiously optimistic that we may have been able to pull her back from this brink. We have closed her Tumblr account. My husband and I have been confronting her about thinking she is trans. We haven’t been yelling or ugly or angry. We have just been telling her what we think, how we are seeing things. Partly because of this blog, we have been able to avoid going through the, “Really? Well if you say so. That is great, I guess!” stage. Right when we got wind of this, we have just been very up front that there is something dangerous going on in society and that we will not tolerate her playing around with this. We are going to continue talking to her.

As a mother and a therapist, I have been stunned and saddened to the extent by which I feel silenced, both personally and professionally. I am afraid to discuss my concerns about my daughter with friends for fear of feeling judged and being accused of being a horrible mom who will damage my child. (Certain friends of mine have circulated petitions decrying thoughtful op-ed pieces in major newspapers that were approaching Caitlyn Jenner’s transition with some well-considered feminist questioning.) I am afraid of speaking up in professional circles about the phenomenon more generally for fear of drawing ire and misapprehension. It is so frightening to think that therapy for my daughter doesn’t feel like a safe option, since the process might be so easily hijacked just by the mention of the word “trans.”

As a therapist, I mostly work with adults. A common reason for seeking therapy is being at a place where you are wondering about leaving your marriage. When a woman (or man) comes in, they usually say something like, “I haven’t been happy in my marriage for a long time. My husband isn’t a terrible person, but I just don’t know if I can stay.” What I don’t say at that point is, “Well, if you are wondering that, it must mean that you need to leave the marriage. To stay any longer would be a terrible mistake. Here is the name of a divorce attorney.”

Ending a marriage is a huge deal. There are enormous consequences for several people, even when children aren’t involved. It isn’t a decision to be taken lightly. When a client says to me that they are thinking of leaving, I believe my job is to help create the space for them to explore this as a possibility without judgment in either direction. I want to provide complete acceptance of all of their explorations. It isn’t my job to interpret their feelings or tell them what to do. I listen. I ask questions. I reflect back what I hear. I neither rush them forward nor try to hold them back. It is a slow careful process of discernment, as it should be. There is a marriage in the balance.

I believe that open-ended non-judgmental exploration is the very essence of the therapeutic process. The current prohibition on exploring a patient’s feelings of gender dysphoria seems a perversion of this process. I would feel that I had done someone a terrible disservice by imposing an external yardstick on someone’s private decision as to whether to divorce. The potential for harm is so great! How much greater is the potential for harm when we are talking about impressionable young people electing to undergo permanent sterilization?

This is very lonely, and very frightening.

 

The trans-kid honeymoon is sweet—while it lasts

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

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

were positively correlated with postsurgical subjective well-being.

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

by fightingunreality

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

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

hormone graph 2

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Blocking puberty–and the right to an identity crisis

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

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

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

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

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

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

Erik-Erikson-portrait

Erik Erikson

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Cognitive scientist Jay Giedd:

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

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

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

But is anyone preparing for the worst?

If you care for “trans” kids, fight for freedom from gender, not the scalpel & syringe

I received this comment a few days ago. The theme is a common one among trans activists and gender specialists nowadays: They not only think they know how to diagnose “true trans” children. They are confident that social transition, puberty blocking, and cross sex hormones (with concomitant permanent sterilization) will lead to happy trans adults.

I’ve reproduced the comment here. (Boldface emphasis is my own.) My response is below.


LisaM says:

People are always mixing up Gender Non Conforming Only children, GNC Only, (usually first defined by their parents) and transgender children (those who show strong cross gender desires and associated Gender Dysphoria, GD, if thwarted).

Now GNC Only (little or no transgender desires and the associated GD) will fairly often, but not always by any means, end up bi-sexual, gay or lesbian as adolescents and adults and be happy with their gender (maybe after some exploration).

GNC with strong GD will nearly always retain that into adolescence and adulthood and at some stage transition or die.

So it is important to separate them out, which to be fair for a very young child can take a few years to work out, hence the WPATH ’support and wait and see’ approach.

The longer a child expresses transgender desires and has GD then the more likely they are really transgender. But, an important but, a child with strong GD may not be a ‘typical’* ‘sissy boy’ or ‘tomboy’. though they will almost certainly show GNC behaviour of some kind and strongly express transgender wishes.

A lot of that depends on how introverted or extroverted they are. The quiet, shy, sensitive and introverted child suffering terrible GD may not express themselves much in public as very GNC even though they may want to. Everyone forgets this point…… not every kid is a blazing extrovert and public performer. This explains the common issue of the child only expressing their transgender feelings at early adolescence, before that they were simply too shy and sensitive and hid it carefully.

The other issue is the treatment of some GNC Only kids, who if you do the ‘drop the Barbie’ stuff to them means you are making them act ‘straight’, which is cruel and if not actual SOCE** it is pretty close.

GNC Only behaviour by itself will not ‘make’ someone transgender, which seems to be the fear by some.
GD plus GNC means they are almost certainly transgender and almost never will change and if you try then you are playing Russian roulette with their lives. There is only one treatment for GD that works, transition***.

So the issue is selection and it is not that hard, although it will never be perfect. A 2012 study on CAMH children showed the only statistically significant factor (logistic regression) in their ‘persistence’ was the strength of their combined GNC/GD scores. So their own tests showed good measures to predict outcomes, which were a lot higher that the commonly stated ‘80% desist’ (based on lumping the two groups together).

A rough ‘back of the envelope’ calculation shows that maybe only 5% of GNC Only diagnosed kids are really transgender (diagnosis is never perfect). BUT, maybe as much as 80% to 90% of GNC + strong GD ones are (based on CAMH published numbers).

The majority, by far, are of course GNC Only with transgender children being a minority. CAMH’s own numbers (awhile back) stated that 70% of the kids they saw were GNC Only.

*And what is a typical ‘sissy boy’ or ‘tomboy’ anyway? This is usually just parent paranoia and absurd social ‘norms’.

**Sexual Orientation Change Efforts = sexuality reparative therapy.

***transition can mean socially or fully medically to the opposite gender, it can also mean becoming ‘gender queer’ or similar.

LisaM, first let me acknowledge that you are not arguing in your comment for full medical transition for all “transgender children.” In fact, you say that some kids may just want to “transition” to be “genderqueer.” But really, that is simply a matter of personality. We don’t need to label it with anything to do with “gender,” unless you believe in gender stereotypes. So it’s nonsensical to say such kids would be “transitioning” to anything–they’re just expressing their unique personalities, as well they should.

But apart from that statement on your part, I’ve done enough homework to know that medical transition is indeed the goal and outcome in an increasing number of pediatric cases. Much of my response will be addressing that outcome.

You don’t disagree, in the main, with the decades of peer-reviewed data that show most GNC kids will desist. What you and the other WPATHers are arguing about is the small core of kids who persist in their dysphoria as preadolescents.

WPATH activists and gender specialists are pretty confident that they’ve come up with a way to separate the “truly transgender child” from the merely “gender nonconforming” (GNC).  GD + GNC = transgender for life and in need of transition. To hear them tell it, it’s a slam-dunk. They eschew the older research because they say the net was cast too widely; that the “truly trans” kids were lumped in with merely gender nonconforming.

Here’s what I’m willing to grant:

  • There are a minority of kids who appear to be more persistent in their desire or claim to be the opposite sex.
  • Some of those kids might continue to want to “transition” as adults.
  • Some of the older studies may have been less specific in weeding out the more dysphoric from the merely GNC children.
  • Responsible, ethical clinicians don’t want to create “false positives” i.e., kids being trans’ed who would have grown out of it. They aren’t ogres.

Beyond that? What do you and other trans activists have to support medical transition of children?

That’s pretty much it.

You claim “there is only one treatment that works for gender dysphoria, transition.” But there is zero proof that the medical transition of children will produce happy adults decades later. There simply isn’t.

History and science don’t support the “transition early or suicide” narrative:

  • Show me the data proving that gender dysphoric children in earlier times didn’t end up living happy lives; that they committed suicide in the days before hormonal and surgical interventions were widely available.
  • Show me the data that dysphoric kids who are medically transitioned will be happier at 40 than kids who weren’t transitioned.
  • Show me proof that the very act of transitioning kids doesn’t create persistence. Especially because “social transition” is now being started earlier and earlier, when children are at their most impressionable and the brain is most plastic.  Do you know anything about normal child development?
  • Show me the data that the “two spirit” and GNC people in other non-technological cultures (that trans activists often co-opt) spend their days wanting to kill themselves because they can’t have surgery and hormones.
  • Show me proof that there is any such thing as innate gender identity.
  • Show me the data that these children won’t feel suicidal later on in life, after the “honeymoon phase” of transition has long passed. (In point of fact, way too many young people who are gender nonconforming, gay, or trans-identified have suicidal thoughts, and transition hasn’t prevented self harm in many.)

What is the big rush to transition kids, to prevent them from experiencing the “wrong puberty”?  I believe it is driven by adult trans activists obsessing about the fact that they didn’t–or still don’t–“pass” well enough. It’s about how realistic a facsimile of the opposite sex the endocrinologists and surgeons can manufacture.

The engine that drives this pediatric transition juggernaut is the memories and yearnings activists carry about their own childhoods. That’s what this whole medical-legal-media child transition craze is based upon: The anecdotal accounts of adult trans.

Anecdotes are fine, as far as they go. But why don’t trans activists give as much weight to anecdotes by formerly dysphoric people who are glad they were born before transition was a thing for kids? 

Based on their own retroactive wishes, trans activists are betting that all these kids who are being socially transitioned, puberty blocked, and sterilized are going to be happy adults — at 30, 40, 50 years old.

LisaM, in the name of helping these kids “pass” better as adults, it goes without saying that you and other activists also think it’s worth sacrificing a few false positives. As you said, “it will never be perfect.” Tell me: How many false positives do you think will be acceptable in the future? Regretful adults who were puberty blocked, sterilized, and operated upon, only to discover that they changed their minds later?

We’re talking about clinical guesswork with extremely high stakes. And it’s coupled with an activist strategy that is making it illegal to have a control group of kids who didn’t receive such “treatment.” The only “control group” will be future regretters (like you said, no diagnosis is perfect) who will haunt courthouses and psychotherapists’ offices long after the damage is done.

In the name of preventing the “wrong puberty,” you want to interrupt the natural course of development by blocking puberty and preventing these kids from discovering who they are without medical interference. You ignore the fact that a puberty-blocked kid also has blocked brain development because puberty isn’t just about secondary sex characteristics. It’s also about brain maturation. And by preventing natural puberty, you deny them the right to a first sexual experience in an unaltered body.  You give these kids what they say they want, thinking you are doing the right thing, contradicting decades of clinical practice, neuroscience, and child developmental psychology in thrall to a non-evidence-based belief in innate gender identity.

You think it’s all worth it—the sterilization, the false positives, the denial of puberty–because you have convinced yourselves that these kids will be happy adults.

But you don’t know that. Even the top doctors in the field admit it. The Dutch pioneers in the field of pediatric transition are uncertain.

You and your compatriots spend a prodigious amount of time and energy fighting for  children to be permanently sterilized and irretrievably altered. What would happen if, instead, you and the other trans activists formed lobbying groups to fight for full acceptance and understanding of gender nonconformity? Make the idea of having to “pass” a thing of the past, so that a little boy or girl would see adults and children who dressed and behaved and did anything they wanted, without the need and the encouragement to think there is something wrong with their bodies. Do you really think most of these “true trans” kids would still want to “transition?” Or that, at a minimum, they couldn’t just wait until adulthood to make the decision?

Trans activists believe strongly that transgender should be depathologized and seen as a normal variation in human experience. But there’s an inherent contradiction here. Setting aside the question of whether insurance and the medical system should pay for any and all interventions for something that is a “normal variation,” if it’s normal to feel “trans” or “genderqueer,” why don’t you fight for normalization of gender nonconformity?  What’s wrong with a 6’2 man in a dress? A normal variation shouldn’t require modern Western medical intervention, should it? Not everyone, everywhere in the world can afford that, can they?

Think of what you could do with your time and money, fighting for acceptance of children to be who they are, without thinking there’s something so wrong with their bodies that they have to be cut and drugged to feel whole. Think of the good you could do instead of agreeing with preschoolers that they might “really” not be a boy or girl.

“Girls can be anything!  Just because you like/play/feel [fill in the blank], you’re still a girl. A really cool girl!”

How on earth can anyone think that making it easier for an impressionable young child to want to undergo permanent medical changes is the most compassionate path? Wouldn’t it be kinder to fight against the need to conform to stereotypes in the first place?

 

 

Groundbreaking study: Kids mean what they say

The clinic advised that Rudy should start to make his own choices and, specifically, recommended that he was allowed to pick an item of clothing. ‘He chose a Disney princess nightie and skipped around the house in it, laughing,’ recalls Kathryn. Towards the end of Year 1 at school, Rudy started wearing girls’ clothes at home. ‘Of course, he chose to dress as a girl. I watched him at the disco, chatting to girls, wearing a pink glittery dress. That was a turning point.’ Back home, Rudy chose a girl’s school uniform for the new term and asked to be called Ruby.

–Parenting a transgender child: The day my four-year-old son told me he was a girl

 


When Ana was five years old, her mother Cathy organised a birthday party with one rather unusual condition: No girly presents, please. ‘I felt awful doing it, but I knew Ana would be devastated if anything pink or fluffy turned up.’

‘I knew when I was growing up,’ says Alfie now, ‘that I didn’t want to do the things that girls did. I was the sort of kid who ran around and got dirty. … People thought me being a tomboy was a phase, but I knew I wouldn’t change. I didn’t want to wear girl clothes. I hated the way they fitted to me. … I was told I would change and get interested in make-up, but I could never see it happening.’ The paediatrician then brought up the topic of gender transition. So in the car on the way home, I said to mum: ‘I think I’m transgender.’

–My child had a boy’s brain in a girl’s body


Trans activists and gender specialists don’t have much in the way of well controlled, peer-reviewed research to support their core assumption that “gender identity” is innate and immutable. Some of the latest brain science shows little difference between male and female brains. But leaving that aside, what is the scientific basis for believing there is an innate “gender identity,” baked in at birth, that would justify turning young people into sterilized, permanent medical patients as adults?

Recently, in the activist blogosphere, the transgender press, and on the WPATH Facebook page, there have been excited proclamations that data to prove “true identity” has emerged in the form of a paper published a few months ago in the journal Psychological Science. The study of 32 “transgender” children and the same number of non-trans controls, entitled “Gender Cognition in Transgender Children,” [abstract; full study here] was conducted by University of Washington assistant professor of psychology and director of its TransYouth Project  Kristina Olson (not to be confused with LA Children’s Hospital gender specialist Johanna Olson), along with transgender activist Aidan Key and Stony Brook University assistant professor of psychology Nicholas Eaton.

I’m going to start with the punch line and work backwards from there: The study demonstrates only that 32 socially transitioned children (that is, kids who are being “supported” by their families and “gender specialists” in being referred to by an opposite sex name, pronouns, and presumably, though the authors don’t tell us, sporting opposite-sex-stereotyped clothing and hairstyles), really, truly do prefer the playmates, hairstyles, and clothing more typical of the opposite sex. Further, these “transgender children” really and truly do prefer and “identify with” the same playmates and physical attributes as the control group of “cisgender” children (yes, the study authors use that term) of the opposite sex.

Who were the “transgender children” recruited for the study?

To be included in the current study, children had to be 5 to 12 years old and live in all contexts as the gender expression “opposite” of their natal sex. These requirements resulted in the exclusion of 4 additional gender-nonconforming participants

And the control group?

Thirty-two control participants (20 female, 12 male; mean age = 9 years) … matched to the transgender participants were recruited through the first author’s research lab from a database of families interested in participating in developmental psychology research studies. They were required to have no significant history of gender nonconformity.

[Note: A group of “cisgender” siblings of the “transgender” children were also part of the study, but time and space in this article do not allow a full analysis of their responses, which were similar to but not the same as the non-familial “cisgender” control group.]

What do the authors mean by “gender nonconforming” or “no significant history of gender nonconformity”? This is never defined, although we can guess that the “transgender” children dress, play, and appear differently from generally recognized gender stereotypes. But the control group? Do the authors mean these children entirely conformed to stereotypes—i.e., the girls all wore dresses, played with dolls, and had long hair, while the boys played with trucks, had short hair and wore rough-and-tumble   trousers?

Olson et al don’t tell us. And what about the four excluded “gender nonconforming” subjects, who apparently did not “live in all contexts” as “opposite” to their natal sex? Did these children occasionally indulge in sex-stereotyped play and behaviors, so they weren’t “trans” enough?

The study stimuli consisted of questions coupled with pictures of boys and girls, “matched for approximate age and attractiveness.” (And what does “attractiveness” mean? There is an even bigger question vis-à-vis these pictures, which I will get to in a few moments).

Olson and colleagues tested the children in 3 areas:

  • Gender preference (for play/friendship)
  • Object preference (associating a nonsense word with a picture of a boy or girl,  saying this was the name of a toy or food that the pictured child was using)
  • Gender identity (whether the child feels they are a boy or girl)

Each of these three variables were addressed via explicit (i.e., responses to direct questions)  and implicit measures.

What’s the difference between explicit and implicit measures? In psychology research, it has been posited that “implicit” measures

 may resist self-presentational forces that can mask personally or socially undesirable evaluative associations

In other words, implicit measures are meant to get at how someone really thinks and feels, whereas a reliance strictly on explicit “self reporting” might be tainted by what a subject thinks someone wants to hear (or other motives).

So, for the “gender preference” part of the Olson et al study, the explicit measure was to ask the child, “who would you rather be friends with?” when shown a pair of pictures of a boy and girl. The implicit measure was to show the children pictures of a boy and girl and ask to label them “good” or “bad.”  (The underlying premise here is that most pre-pubescent kids prefer their own “gender” as playmates).

For gender identity, the implicit measure consisted of asking the research subjects to label pictures of boys and girls as “me” or “not me.” The explicit corollary was

telling them that people have outsides (their physical body) and insides (their feelings, thoughts, and mind). They were told that some people feel like they are boys on the outside, and some feel like they are girls  on the outside, and that those people might feel the same way or different on the inside. They were told some people feel, for example, like a boy on the outside and inside, and that others feel like a boy on the outside but a girl on the inside. Further, they were told that some people feel like both or neither, or that their feelings change over time.

Children were asked whether, on the inside, they felt like a boy, a girl, neither, or both; whether their gender identity changed over time; or whether they did not know.

For “object preferences” the authors didn’t assess preference for actual objects, but only whether the research subjects chose the same preferences as pictured  boys or girls. They were

shown pairs of photographs of children and told that each one had a preferred toy or food. The names of these items were in fact novel words (e.g., “This is Amanda and she likes to play flerp. This is Andrew and he likes to play babber.”). Our interest here was whether children would use the gender of the person endorsing the item to inform their own preferences.

It’s difficult to see how this adds any more information than asking kids what sex playmates they prefer. If a child who “identifies” as a boy sees a picture of a boy playing “babber,” that child would likely prefer to do what the pictured boy is doing.

Be that as it may, what exactly did Olson et al set out to prove with these probes?

… if these children are not confused, delayed, or pretending, and in fact their expressed gender represents their true identity, we would expect them to respond   similarly to gender-matched control participants not only on self-report measures, but also on implicit ones.

We reasoned that if children are confused by the particular questions posed to them….[or] if they are merely self-reporting the “wrong” gender identity… or even if they are just oppositionally reacting to the question of their gender identity— …these children should show one of two patterns of confusion. First, they could be truly confused, as indicated by random responding and no systematic  response across measures and participants. Alternatively, they could implicitly identify as their natal sex (because they actually understand gender and are merely self reporting this “incorrect” gender).

And the results of the study? Surprise—the socially transitioned “transgender” children did indeed respond similarly to the “cisgender” control group.

But what does this actually demonstrate?

First, let’s consider the stimuli, consisting of pictures of age-matched boys and girls. What would distinguish a picture of a prepubescent boy from a picture of a prepubescent girl,  apart from clothing and hair styles? Not much.

Prior to puberty and the influence of estrogen or testosterone, school-aged kids look much the same. So unless the pictured boys and girls had identical haircuts and clothing, the 32 “transgender” children labeling a boy or girl picture as “me” or “not me” would have been identifying with a boy or girl based on stereotyped dress and appearance—haircuts, clothing, and the like. How could it be otherwise?

Put another way, if the pictures of the boys and girls did all have the same haircut and clothes, irrespective of biological sex, would the research subjects have been able to identify the sex of the child they identified with? Likely not.

Now, to the question of whether these kids were confused, delayed, or pretending, the authors did show that these kids are not likely to be knowingly pretending to be the opposite sex, nor are they “confused” i.e., they just don’t know what they think or feel. But why is this of much significance?  What would be the motivation for these children to “merely” self report the “incorrect” gender, or to “oppositionally react”? The fact that these kids are sincere in their convictions is reported by Olson et al as an important finding, but does anyone, including critics of pediatric transition like myself, doubt that dysphoric or trans-identified kids really mean their gender nonconformity?

Further,  deliberately “pretending” in order to deceive is not the same as conflating fantasy or desire with objective reality–an aspect of normal childhood development which activists, gender specialists, and researchers like these seem never to have heard of. Just because a child  sincerely sees him or herself as the opposite sex does not make it true.  Child psychologists have known for decades that children’s firmly held beliefs do not always comport with reality.

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

The authors seem not to have thought of the most obvious conclusion: That these kids DO believe they are the opposite sex but that doesn’t make it so—especially since even the implicit measures the authors seem to think are so meaningful are nothing more than identification with gender-stereotyped activities and appearances which they happen to prefer.

By demonstrating that the “transgender” children aren’t just being obstinate or dishonest, Olson et al seem to believe that their study indicates (in their words) “true identity” in the children they have labeled “transgender.”

But what is “true identity?” Is it the elusive Holy Grail of inborn, unchangeable gender, something no one has come remotely close to proving, yet is the unquestioned assumption from which all the current medical and psychological and legal decisions about “transgender children” have flowed in the last few years?

That the authors even use the term “true identity,” which they themselves admit is unproven, is all we need to show the study is fatally tainted by confirmation bias.

 Confirmation bias, as the term is typically used in the psychological literature, connotes the seeking or interpreting of evidence in ways that are partial to existing beliefs, expectations, or a hypothesis in hand.

–Confirmation Bias: A Ubiquitous Phenomenon in Many Guises, by Raymond S. Nickerson,  Tufts University

It’s quite clear that the authors’ “hypothesis in hand” is that there is such a thing as “true identity.” Further, they interpret the evidence that “transgender” children feel as strongly about their identity and gender nonconformity as “cisgender” children do as somehow confirming this hypothesis. Even though they themselves in their Notes section  of the study assert:

  1. We avoid using common colloquial phrases such as “born as a boy” because they suggest that transgender identities are not innate (an unresolved scientific question) and are thus offensive to some individuals.

 On the one hand, because they don’t want to be “offensive” to “some individuals” (and I think we can guess who they are), Olson et al don’t want to “suggest” that gender isn’t innate (and in fact present their study as evidence that their “transgender” research subjects have a “true identity,”). But at the same time, the authors explicitly acknowledge that the question of “innate” gender identity is an “unresolved scientific question.”

But while being careful not to offend “some” people, they don’t have any trouble splattering the term “cisgender” throughout this article,  despite the fact that some other individuals find “cis,” well—offensive. Certainly Olson et al aren’t living in such a bubble that they are unaware that the label “cisgender” is repugnant to many of us who the transgender community apply it to.

And in point 2 in the Notes, we have a further indication that the authors’ work is riddled with confirmation bias:

2. We use the term “opposite” for clarity but acknowledge that gender is not binary.

They “acknowledge” that gender is not binary. But as with “innate  gender identity,” who has proven that “gender is not binary?”  No one. This jargon comes straight from the trans activist lexicon.

In peer-reviewed research, investigators always indicate the limitations and possible flaws in their study.  The weaknesses I’ve pointed out in this post are not even marginally addressed by the authors. What limitations do Olson et al concede?

 All of the participants tested here identified and lived life as one gender at the time of assessment, choosing names consistent with that gender and preferring those pronouns as well. Future studies along the spectrum of childhood transgender experiences will be needed to clarify how generalizable these findings are to children who have different degrees of identified gender expression or to those with different life experiences.

Apparently what’s next is seeing whether their study measures can also be used to prove the “true” identities of “gender fluid,” “genderqueer,” and “nonbinary” children. I wonder what exclusion criteria they’ll have in future studies? Hopefully they will be more precise in their definitions of what constitutes gender (non)conformity in their next paper.

In their summary, Olson et al reiterate their key finding that these kids really mean it when they say they prefer the lifestyle of the opposite sex:

In summary, our findings refute the assumption that transgender children are simply confused by the questions at hand, delayed, pretending, or being oppositional. Instead, transgender children show responses that look largely indistinguishable from those of cisgender children, who match transgender children’s gender expression on both more- and less-controllable measures. Further, and addressing the broader concern about transgender individuals’ mere existence raised at the outset of this article,the data reported here should serve as evidence that transgender children do indeed exist and that their identity is a deeply held one.

“Do indeed exist.” Of course children who believe they are, or want to be, the opposite sex “exist.” And of course such children are going to exhibit preferences for the appearances and activities of the opposite sex, in a “deeply held” way. But it doesn’t follow that those children are somehow innately the opposite sex.

All Olson and colleagues have demonstrated is that some children really, really, really want to be the opposite sex; even to the point of saying they are the opposite sex. They want to look and dress like the opposite sex—a girl, for instance, might want a short haircut and to wear comfortable boys’ clothes. They like playing with children of the opposite sex. And they like doing things that the opposite sex likes to do. In other words, these kids are don’t conform to the more typical behaviors of their birth sex. But does it then follow that they should be encouraged and conditioned to believe they are the opposite sex, leading them in the near future to puberty blockers and on to sterilization and surgeries?

If the stakes were not so incredibly high, a study like this could simply be filed away under “strongly held beliefs and desires of gender nonconforming children.” But given the fact that so many activists and gender specialists are in the business of promoting medical transition, this study should instead be filed under “confirmation bias rationalizes non-evidence-based medical experimentation on vulnerable children.” What Olson et al have not proven is innate gender identity. All they have shown is that these kids really mean it when they say they are or want to be the opposite sex.

This study, instead of being promoted as a rationale for pediatric transition, should carry no more weight than any of the thousands of media articles trumpeting the unsubstantiated yet continuously promoted idea that children who refuse to conform to gender stereotypes—yes, who really mean it when they say they want to look and play and dress like the opposite sex—are “transgender.” Like the ones quoted at the beginning of this article. Or the thousands of others that have been published in the last few years. Like this one:

Tom charges about in a Batman costume, brandishing a sword. …Tom loves dressing up. “Normally as a superhero,” Cassie [his mom] says.

“Batman and Superman,” Tom adds. “And Wolverine!” He also likes to play cowboys or policemen with his best friend, Charlie. “Sometimes we arrest people. Remember when we did it yesterday to the dog?” He grins. “He wasn’t putting the ball down.” He shows me his bedroom. There’s his treasured Playmobil pirate ship, his Marvel poster featuring Ironman, Captain America and the Hulk, and his pencil case shaped like a football boot.

When Cassie took three-year-old Tom to the barber for the first time, she wept. “That was the final thing. If I let him get his hair cut short, that was me accepting he is a boy.” The hairdresser was bemused. “I was crying and I had this little boy with me who had hair down to his arse. She asked him: ‘Has your mummy never let you get your hair cut?’ And he loved it, because she thought he was a boy with long hair.” After that, Tom never got mistaken for a girl, and became much happier.

Transgender children: ‘This is who he is – I have to respect that’

 

7-year-old “trans activist” used in campaign by Transgender Europe, a German NGO partially funded by US State Department

US taxpayers, did you know that some of your hard-earned money goes to a foreign NGO which uses a 7-year-old child to promote a trans activist agenda? Transgender Europe (TGEU), which is celebrating its 10th anniversary, states on its website (see bottom of page) that the US State Department is a donor.

TGEU State Dept funding

How is it that a US government agency is funding a foreign trans activist organization?

President Obama issued a directive in December 2011 to heads of executive branch agencies (which would include the US Department of State):

I am deeply concerned by the violence and discrimination targeting LGBT persons around the world whether it is passing laws that criminalize LGBT status, beating citizens simply for joining peaceful LGBT pride celebrations, or killing men, women, and children for their perceived sexual orientation.

President Obama’s memorandum goes on to list five areas for support of foreign NGOs: Combating Criminalization of LGBT Status or Conduct Abroad, Protecting Vulnerable LGBT Refugees and Asylum Seekers, Foreign Assistance to Protect Human Rights and Advance Nondiscrimination, Swift and Meaningful U.S. Responses to Human Rights Abuses of LGBT Persons Abroad, Engaging International Organizations in the Fight Against LGBT Discrimination.

Pursuant to the memorandum, the Global Equality Fund was established as a funding mechanism, “a collaborative effort led by the U.S. Department of State, bridging government, companies and NGOs with the objective of empowering LGBT persons to live freely and without discrimination.”

In September 2014, the US embassy in Budapest issued a statement on their website:

…Charge d’Affaires  of the U.S. Embassy in Budapest, M. Andre Goodfriend, delivered opening remarks at the 5th European Transgender Council Meeting, a gathering of 200 transgender activists, allies, researchers, and funders, in Budapest, Hungary – the first such conference to take place in Central and Eastern Europe. …

He congratulated the activists on the success of their efforts thus far, and emphasized that holding the conference sent a strong signal that the human rights of transgender persons should be protected everywhere.

The Department remains committed to advancing the goals of the Presidential Memorandum on International Initiatives to Advance the Human Rights of LGBT Persons, and to expanding its support, through the Global Equality Fund, embassy and consulate outreach, partnership with like-minded governments, corporations, and private foundations, and by continuing to learn from and partner with civil society organizations – such as Transgender Europe and TransVanilla [a Hungarian trans activist organization]- to promote and protect the human rights of transgender persons.

If the US State Department was only involved in “promoting and protecting human rights” and helping people to live “freely and without discrimination;” if it were about the right to nondiscrimination in jobs, housing, education; the right to protection against violence for all LGBT people, I’d be completely on board. But organizations like TGEU are taking this further.

Production values on the 1.5 minute promo featuring the 7-year-old are high. The video was clearly made by skilled professionals, with excellent camera work, fine sound engineering, and a catchy guitar soundtrack. This is not the work of an amateur.

The child also has a “public figure” Facebook page (aka a fan page), adorned with stereotypically “feminine” trappings, and describing the child as “a 7-year-old trans activist.”

WN Facebook

What is the 7-year-old trans activist being used to promote? The “depathologisation” of trans people. On its website, TGEU “calls on the World Health Organisation and governments to ensure that gender variant children are not labelled as sick.”

So far? Sounds good. Gender nonconformity is not a pathology. Let little girls and little boys look, play, and behave any way they like.  Is this what TGEU is promoting?

The Depathologisation Resources page links to this proposal by the GATE working group, which argues for abolishing the “gender incongruence” diagnosis being considered for the next version of the international diagnosis codes (ICD-11). The group praises Argentina, which

… passed the first gender identity law in the world that recognizes the human right of trans people to access legal recognition and transition-related health care services (including hormone therapy and surgical procedures) without requiring any kind of diagnosis.

So depathologizing appears to mean dumping any “disorder” diagnosis and just giving trans-identified people whatever they want. But for children, TGEU seems to argue for a different approach:

Gender variance in childhood does not require any medical interventions such as hormone therapy or surgical procedures. Rather, children need information and support in exploring their gender identity and expression and dealing with sociocultural environments that are frequently hostile to gender variance…research indicates it is impossible to reliably distinguish between a gender-variant child who will grow up to become trans and a gender-variant child who will grow up to be gay, lesbian, or bisexual, but not trans. As such, by conflating gender variance and sexual orientation, the proposed GIC category amounts to a re-pathologization of homosexuality.

Later in the document, we find this:

Further, the imposition of a diagnosis of gender incongruence on a child contradicts the principle that childhood development is a process of change and exploration. Such a diagnosis, which attempts to establish a concrete definition of a child’s gender identity precisely during the phase of life when essential aspects of identity are most in flux, is likely to create the presumption that the child is transgender, whether or not that is in fact the case.

This sounds like TGEU falls squarely in the camp that would criticize labeling children as trans, doesn’t it?

Yet in the video, the 7-year-old isn’t talking about  being “gender variant.” The kid is a boy talking about living as a trans person. A girl. If TGEU believes that children should not be presumed to be transgender, why on earth are they promoting this child as a “trans activist”?

The child’s parents are also featured on the website. What are their views on the “depathologisation” question?

Bex and James are the Family Support Officers at Gender Liberation, and Willa is the youngest activist….

As parents of a trans child they were concerned that ‘gender incongruence in childhood’ is listed in the International Classification of Diseases, particularly because others could use this classification as a tool to deter them from supporting their daughter, and it could further stigmatise Willa and keep people from accepting her.

We made the choice, we made the decision that we had to listen to our child, because we love her unconditionally.”

“Trans children only need to go through social transition, and therefore having a category in the ICD-11 that pathologizes gender diversity in childhood is completely unnecessary.”

big special girl

“She’s my special big girl and always will be.”

And there we have it.  “Gender variant” children “need” to go through social transition. Yet the very document TGEU uses in their depathologisation campaign states that the majority of these kids will desist and perhaps grow up to be gay or lesbian adults. That there should not be a “presumption” that they are transgender.

In addition, there is a body of evidence, originating with and continuing to this day, from the Dutch team who pioneered pediatric transition, indicating that social transition can be harmful. It can lock a child into a transgender identity and make it more difficult for a child to “desist.” Not only that: Being a social media star and receiving plaudits from parents and other important adults for conforming to gender stereotypes is a powerful incentive and reward. And this particular child has had a law dedicated to him. Can anyone think it would be possible for him to change his mind, after all that?

So why do they “need” social transition?  Why can’t these kids just play and explore without being coddled in the notion that they are really the opposite sex? Why do they “need” to be called “trans activists” at age 7?  What does TGEU actually believe?

Watch the video and decide for yourself: Is this 7-year-old child being encouraged to “explore their gender identity and expression”? Or would you say the child is more being urged to assume a “concrete definition…precisely during the phase of life when essential aspects of identity are most in flux… likely to create the presumption that the child is transgender”?

My life having to live as a boy was very bad. Until one day I told my mum and dad that I felt I was a girl….so they let me dress as a girl indoors….they let me live as a girl…after that when they saw that this was truly who I was they let me live as a girl….Now I am very happy living as a girl… trans kids need to be listened to. We don’t have a disorder and you can’t change us. .. we should just be allowed to live as we are because we KNOW who we are.

butterflies

So there’s agreement between organizations like Transgender Europe and critics like me. These kids aren’t “sick.” They don’t have a “disorder” just because they aren’t conforming to rigid gender stereotypes. But we differ radically in the conclusions we draw.

Transgender Europe operates campaigns—partially funded by me and other Americans–that promote the idea that a boy who plays with fairy dolls and wears pink dresses is actually a girl who should be “socially transitioned” before the world on YouTube and Facebook, defined as transgender, and who, at puberty, will be ready for all the medical services that money (and the taxpayer) can provide.

Skeptical ethicist: “A medical doctor is not a candy seller”

candy seller

In yesterday’s post, I focused on the situation in the United Kingdom, where the school system is deeply enmeshed with a trans activist organization which peddles its message to kids as young as 4 years old. And the majority of posts on this blog document the seemingly unstoppable trend to diagnose and treat children as “transgender.” With this overwhelming level of societal and medical support, the issue must be pretty much settled—right?

Not according to the gender specialists themselves, it isn’t.

Hot off the presses, in the October 2015 issue of the Journal of Adolescent Health, a team of Dutch researcher-clinicians report findings from a survey of gender clinics which serve dysphoric children around the world.

Although you’d never know it, judging by the accelerating trend to socially “transition” kids as young as 3, freeze adolescents’ natural puberty with GnRh agonists, and then move on to chemical sterilization via cross-sex hormones thereafter, there is no  consensus amongst gender specialists that this current treatment protocol is the way to go.

The qualitative survey, entitled “Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study” was conducted by a group of well-known Dutch researchers/gender specialists who are themselves actively involved in administering puberty blockers and other treatments to “transgender” children. The authors surveyed 17 treatment teams (endocrinologists, psychologists, MDs, psychiatrists, ethicists) regarding their views and experiences.

Many of the parents who contribute to and read this blog agonize about their difficulty finding therapists and doctors critical of the I’m-trans-if-I-say-I-am paradigm. I hope this post gives some measure of hope to those parents. While the skeptical specialists (nearly all of them psychologists or psychiatrists, with most endocrinologists and pediatricians apparently submitting pro-transition comments) are quoted anonymously, at least we know they’re out there. And enough of them exist to tell us that the runaway pediatric transition train may not have completely lost its brake pads—yet.

The journal article can be read in its entirety here, and the abstract summarizes the key findings:

The Endocrine Society and the World Professional Association for Transgender Health published guidelines for the treatment of adolescents with gender dysphoria (GD). The guidelines recommend the use of gonadotropin-releasing hormone agonists in adolescence to suppress puberty. However, in actual practice, no consensus exists whether to use these early medical interventions…

Seven themes give rise to different, and even opposing, views on treatment: (1) the (non-)availability of an explanatory model for GD; (2) the nature of GD (normal variation, social construct or [mental] illness); (3) the role of physiological puberty in developing gender identity; (4) the role of comorbidity; (5) possible physical or psychological effects of (refraining from) early medical interventions; (6) child competence and decision making authority; and (7) the role of social context how GD is perceived…

CONCLUSIONS:

As long as debate remains on these seven themes 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.

Because my aim here is to show that gender specialists are not unanimously aboard the child transition bandwagon, this post will mostly highlight the comments from the more skeptical gender specialists surveyed. Amazingly (to me), the doubters seem to hit nearly all the same points I do in my blog posts.  [Note: Use of boldface to emphasize certain passages is my own, not that of the authors.]

So what is gender dysphoria?

Is GD a normal variation of gender expression, a social construct, a medical disease, or a mental illness? In the DSM-5 and the to-be-released ICD-11, the main challenge in classifying GD has been to find a balance between concerns related to the stigmatization of mental disorders and the need for diagnostic categories that facilitate access to health care, payment by insurance companies, and the communication between diverse professions.

I spend a fair amount of time reading articles and social media posts authored by gender specialists. It’s quite evident that there is currently pressure to completely de-stigmatize the transgender diagnosis…yet still find a way to get the “treatment” paid for by private insurance companies (or the taxpayer via public insurance such as Medicare or Medicaid). This thread from the WPATH public Facebook page [commenter names redacted] is illustrative of the dilemma the survey authors point to in the passage above.

wpath gender incongruence

So, this thread seems to indicate that providers are moving away from gender dysphoria as a disorder; even as an experience which causes distress. But why then would there be a need for medical treatment? This conundrum is addressed by the 17-clinic survey authors:

The interviews and questionnaires show that most informants find it difficult to articulate their thoughts about this aspect. Most see GD as neither a disease nor a social construct, but as a normal, but less frequent variation of gender expression. However, some note that you would not need medical procedures to make the lives of people with GD more satisfying if it were merely a normal variation.

Another thread from the WPATH public Facebook page seems to justify transition services for someone who just wants a “joyful and loving life.”

wpath joyful life

But when it comes to young people, at least one psychiatrist in the survey study gives us a less sanguine view of such quality-of-life justifications for medical transition:

“I find it extremely dangerous to let an adolescent undergo a medical treatment without the existence of a pathophysiology and I consider it just a medical experimentation that does not justify the risk to which adolescents are exposed. Gender dysphoria is the only situation in which medical intervention does not cure a sick body, but healthy organs are mutilated in the process of adapting physical and congruent psychological identity.” –Psychiatrist

I feel certain at least a few of the parents who frequent this blog wish they had the office phone number for this reasonable clinician. Amirite?

On the wisdom of puberty blockers

How many of us have asked, “but what if puberty blockers also inhibit the psychological/neurological maturation that comes with puberty–and beyond?” And, because many kids actually outgrow their gender dysphoria, interrupting puberty would deny them the opportunity to become comfortable in their bodies and avoid a life as a permanent medical patient.

It’s a pleasant surprise to see an acknowledgement of some of these concerns here:

In the literature, the concern is raised that interrupting the development of secondary sex characteristics may disrupt the development of a gender identity during puberty that is congruent with the assigned gender. The interviews and questionnaires show that some treatment teams share this view.

One clinician even talks about lesbian women who would have been misdiagnosed as “trans” children in an earlier time.

I have met gay women who identify as women who would certainly have been diagnosed gender dysphoric as children but who, throughout adolescence, came to accept themselves. This might not have happened on puberty blockers.”–Psychologist

So at least one psychologist who works on a pediatric transition team acknowledges what many, formerly gender dysphoric women, say: that if there had been “gender clinics” for kids in the 1950s, 60s, 70s, or 80s, they would not be happy lesbian adults today, but sterilized “trans men.”

Speaking more broadly, another therapist has this to say:

“I believe that, in adolescence, hypothalamic inhibitors should never be given, because they interfere not only with emotional development, but [also] with the integration process among the various internal and external aspects characterizing the transition to adulthood.” –Psychiatrist

On co-occurring psychological/psychiatric issues

If you read through the part of this blog where most parents congregate and introduce themselves for the first time, some common themes emerge. One is the observation by many parents that their kids have other mental health issues, nearly always predating the (sometimes sudden) announcement that they are transgender.  While most activists insist that transition is the cure for what ails a dysphoric child or teen, the clinicians working in the trenches aren’t so sure.

The risk of co-occurring psychiatric problems in children and adolescents with GD is high. The percentage of children referred for GD who fulfilled DSM criteria of at least one diagnosis other than GD is 52%. The psychiatric comorbidity in adolescents with GD is 32%. Another study shows that 43% of the children and adolescents seen in a gender identity clinic suffer from major psychopathology. To date, the precise mechanisms that link GD and coexisting psychopathology are unknown.

Miscellaneous physical and psychological risks of medical transition

The surveyed clinicians acknowledge many of the concerns discussed regularly on this blog.

The possible consequences of suppressing puberty for cognitive and brain development are unclear and debated at this moment. The normal pubertal increase in bone mineral density may be attenuated by puberty suppression, and it is uncertain if there is complete catch-up after treatment with cross-sex hormones.

While it only merits one sentence (and no direct quotes), the surveyed clinicians appear to view sterilization as an important concern:

In the interviews and questionnaires, the loss of fertility was often mentioned as a major consequence of treatment.

And here’s an additional worry I haven’t seen in writing before: the potential negative impact of puberty blockers on future SRS surgery.

In addition, various informants stressed the importance of the fact that the penis and scrotum should be developed enough to be able to use this tissue to create a vagina later in life. Very early use of puberty suppression impairs penile growth and consequently makes certain surgical techniques impossible.

Will we see this rather thorny issue discussed on an episode of the Jazz Jennings reality show? Will the Tumblr trans activists screaming “now or never” take heed?

On whether kids are mature enough to make these decisions

One informant stated that the decision whether to start with hormones should only be made during adulthood: “We should facilitate his or her process of integration in the society and if he or she would undergo hormone- and surgical treatments he or she could decide [on this] during adulthood.” —Psychiatrist

Influence of the Internet and social media

You know how trans activists scoff at our observations that our kids only started talking about “transition” after binging on YouTube and Reddit?

They speculated that television shows and information on the Internet may have a negative effect and, for example, lead to medicalization of gender-variant behavior.

They [adolescents] are living in their rooms, on the Internet during night-time, and thinking about this [gender dysphoria]. Then they come to the clinic and they are convinced that this [gender dysphoria] explains all their problems and now they have to be made a boy. I think these kinds of adolescents also take the idea from the media. But of course you cannot prevent this in the current area of free information spreading.” –Psychiatrist

Hello? The Advocate? The Boston Globe? The Washington Post? Anybody?

Furthermore, interviews and questionnaires show that treatment teams feel pressure from parents and adolescents to start with treatment at earlier ages.

Puberty suppression has been adopted as part of the treatment protocol by increasing numbers of originally reluctant treatment teams. More and more treatment teams embrace the Dutch protocol but with a feeling of unease…these professionals also have doubts because of the lack of long-term physical and psychological outcomes.

Hey, journalists. Obscure blogger over here quoting actual gender specialists, so you can’t say it’s just a bunch of nervous Nellie-moms making shit up. Need the link again? Oh, that’s just the abstract, here’s the pre-publication full-text, right here.

Self-harm/suicidal ideation

For several informants, a reason to use puberty suppression was the fear of increased suicidality in untreated adolescents with GD. Research shows that transgender youth are at higher risk of suicidal ideation and suicidal attempts. Nevertheless, caution is needed when interpreting these data because they do not show causality or directionality.

The meaning of that last sentence is crystal clear, and entirely in accord with what I, and other critics of the harmful “transition or suicide” meme that adult trans activists continually propagate, have tried to point out. While no one disputes that there is a higher self-harm and suicidality rate amongst trans-identified young people, there is no evidence that such self-harming behaviors and thoughts are ultimately alleviated by “transition.” Further, as this sentence implies, the “directionality” could be the reverse of what trans activists promote. Having a trans identity and/or facing the monumental prospect of medical transition could be a cause of self harming (in addition to the preexisting or comorbid mental health issues so many of these young people seem to have).

This is not the moment for another flippant call for journalists to take heed. This is deadly serious business: the terrible toll of self harm and suicide among trans-identified youth.  I have not seen a single news treatment of suicide or suicide risk that has even hinted at what these clinicians are stating baldly. Isn’t it time for a more nuanced discussion?


And finally: Leave it to a medical ethicist to point out the huge logical fallacy in the “informed consent” model of treatment now running rampant:

“The fact that somebody wants something badly, does not mean that a health care provider should do it for that reason; a medical doctor is not a candy seller.”— Professor of health care ethics and health law

Imminently sensible. So how is it that “informed consent” and the demonization of “gatekeepers” is more and more the norm? How is it that self identification as trans, even for young children, is fast becoming the only requirement for obtaining treatment? There is something strange going on here. If even some experienced gender specialists  are expressing doubts, why does the media behave as if the issue has been settled?

The positive attitude of many health care providers in giving hypothalamic blockers…is based on the need to conform to international standards, even if they are conscious of a lack of information about medium and long term side effects.” –Psychiatrist

But how can there be “standards” (they are talking about WPATH here) that these providers feel pressure to conform to, if the standards are not based on solid information about risks and benefits? Exactly which cart is pulling this runaway horse?

As still little is known about the etiology of GD and long-term treatment consequences in children and adolescents, there is great need for more systematic interdisciplinary and (worldwide) multicenter research and debate.


Reason for hope?

The article concludes in a way that makes me feel a whisper of hope for the future.

Several professionals mentioned that participation in the study made them think more explicitly about the various themes, and it encouraged them to discuss the issues in their teams. In the Dutch teams, we therefore introduced moral deliberation sessions to talk about these ethical topics. The first reactions of the professionals were positive; the sessions made them rethink essential aspects of the protocol.

Will this “moral deliberation” and “rethinking” result in more caution, or even a desire to put a halt to the pediatric transition train? Time will tell, but it is encouraging that at least the Dutch researchers may be losing some sleep in pondering the incredible power they wield over the lives of children and their families.

At least we know there is controversy. At least we know they are not all marching in lockstep.

And that is something.