The below post is written by Overwhelmed, 4thWaveNow contributor and the mother of a teen daughter who insisted she was transgender, but who subsequently changed her mind. Other parents in the same situation have shared their experiences on 4thWaveNow, and a new research study (currently recruiting) is the first to systematically examine the phenomenon of “trans trending” amongst tweens and teens.
Trans activists and gender specialists constantly assure us that puberty blockers are harmless and “fully reversible.” They claim these drugs “buy time” for a young person to decide if they really are trans. But given that social transition + puberty blockers are followed in 100% of reported cases by cross-sex hormones (see here and here), the “buying time” assertion deserves a lot more scrutiny. If there weren’t other forces at work (like social contagion and the conditioning effect of being validated in the idea that you are “really” the opposite sex if you prefer the appearance and lifestyle of that sex), a 100% persistence rate in trans-identification simply wouldn’t be happening.
And when it comes to teens who experience onset of gender dysphoria in adolescence, parents like Overwhelmed, Penny White, and the founder of this website–who have personally observed their teens voluntarily desisting from a trans identity–are the ones who have actually bought time for their kids: precious time to realize that becoming a lifelong patient haunting the offices of endocrinologists and plastic surgeons is not the only way to live a gender-defiant life.
Earlier this year, a Nature article reported on the May 2016 launch of a study aimed at documenting the psychological and medical impacts of delaying the puberty of trans youth:
Funded by the US National Institutes of Health (NIH), the US $5.7-million project will be not only the largest-ever study of transgender youth, but also only the second to track the psychological effects of delaying puberty — and the first to track its medical impacts. It comes as the NIH and others have begun to spend heavily on research related to the health of transgender people, says Robert Garofalo, a paediatrician at Ann and Robert H. Lurie Children’s Hospital of Chicago, Illinois, and a leader of the study. “We seem to really be at a tipping point,” he adds.
Garofalo and his colleagues aim to recruit 280 adolescents who identify as transgender, and to follow them for at least five years. One group will receive puberty blockers at the beginning of adolescence, and another, older group will receive cross-sex hormones. Their findings could help clinicians to judge how best to help adolescents who are seeking a transition.
Despite the fact that puberty blockers–followed in nearly every case by cross-sex hormones–have been prescribed for many years for “trans kids,” this study will be the FIRST in the United States to track the impacts of medical transition on this population. It has become increasingly popular for gender doctors to start trans-identified children on puberty blockers. The rationale is to avoid the potential psychological distress and the physical development of secondary sex characteristics associated with the “wrong puberty.” Based on the constant onslaught of celebratory articles about “trans kids” in the media, the public is likely unaware that puberty blockers and cross-sex hormones are not approved by the FDA for this purpose. These drugs are being used off-label and the science isn’t settled by any means. Even the gender doctors confess there is no medical consensus.
I appreciate that the Nature piece is not just another one-sided article touting pro-transition dogma. Although the journalist failed to mention that children who pause their natal puberty, and then directly proceed to cross-sex hormones, have the not-so-insignificant consequence of permanent sterility, she did include viewpoints not often seen in the mainstream media:
“But some scientists worry that putting off puberty in older children may disrupt bone and brain development, reducing bone density and leading to cognitive problems.”
“Because most children who question their gender do not do so past adolescence, many psychologists discourage “socially transitioning” until the teenage years.”
The debate is so heated — and evidence so sparse — that the authors of the American Psychiatric Association’s 2013 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) were unable to reach a consensus. “People are making declarations of knowledge that are their belief systems, that aren’t also backed up by empirical research,” says Jack Drescher, a psychiatrist at the William Alanson White Institute in New York City.”
But there is one assertion in the article–touted as settled science—that raises a huge red flag:
“But those who identify as transgender in adolescence almost always do so permanently.”
Many parents who read 4thWaveNow are VERY familiar with this assumption. When their child, out of the blue, with no prior history of gender dysphoria, claims to be transgender, most parents resort to internet searches to become more knowledgeable. They read articles like this one by Irwin Krieger, LCSW, which tells parents it’s pretty much inevitable their teen or young adult child will remain transgender:
…I do acknowledge that most teens who have come out to parents and others as transsexual are truly transsexual so as not to give them any false sense of the likelihood of their child having a change of heart.
Parents are encouraged to just start “supporting” their child by using the correct pronouns, buying new clothes and aiding their child with social (and possibly medical) transition.
Historically (prior to the year 2000), the research data did show that many kids who consistently believed they were the opposite sex during and after puberty held onto this belief into adulthood. But in the last few years, something new has emerged: a wave of post-pubertal, self-diagnosed trans teens. These youth may not fit the historical profile due to relatively recent influences like:
- The social contagion phenomenon. Many confused teens and young adults (and increasingly, tweens) seek out answers from strangers online. They say they don’t “fit in,” that they prefer clothing and activities usually associated with the opposite sex. They ask, “Does this mean I’m transgender?” The answers they receive frequently affirm they are and urge them to “Transition NOW!” Places like Tumblr, Reddit, and YouTube (MTF and FTM transition videos) are full of this “wisdom.” The blog Transgender Reality documents some of these conversations.
Sometimes it isn’t an online influence that sparks a newly realized transgender status. There are more students socially and medically transitioning in high schools and universities. On some campuses there are entire friend groups claiming to be transgender, and an impressionable child who is befriended by this group may suddenly decide he/she is trans as well.
- The ability to achieve an instant “special” status. There is an appeal for some to identify as transgender in order to receive extra attention or boost their social standing.
If a student announces to school administration that they’re transgender, it’s becoming taboo to question them. More schools are enacting guidelines (like this one co-authored by the National Education Association) that enable children to be treated as the opposite sex, regardless of maturity level or mental health status. And parents don’t need to be in agreement, or even informed, about these accommodations.
Additionally, some children and/or their parents may be enticed by the potential to become celebrities. After all, Jazz Jennings and Caitlyn Jenner have their own TV shows strictly based on their transgender identities.
- The reduction in gatekeeping. The current train of thought among gender doctors and therapists is that gender identity is innate, unchangeable, and is often realized at a very young age. If you follow this line of thinking (and assume that no one could possibly be confused or misled into believing they are transgender), then you likely feel it is unjust, and even harmful, to make a child jump through gatekeeping hoops before medical treatment.
As an example of this logic, Dr. Johanna Olson-Kennedy, the medical director of the Center for Transyouth Health and Development at Children’s Hospital in Los Angeles, was recently quoted in this article about Sam who was given puberty blockers, then began testosterone injections and had a double mastectomy all by the age of 14:
“It is pretty well proven that people know their gender by the age of 5,” said the Center for Transyouth Health and Development’s Olson. “If we accept and believe that people know their gender by the age of 5, why not accept that trans kids know their authentic gender?”
Treating young people with gender dysphoria is critical, Olson said, as puberty increases the chances they will harm themselves.
“One of the things that puts trans kids at higher risk is this period of time when they are going through puberty,” she said. “Their body is becoming the adult or permanent version of this body they are not comfortable with.”
- The push for transgender identities to be seen as a normal variation of human existence (like homosexuality). It has become more common for doctors and therapists to avoid labeling people who think they are the opposite sex as having a mental disorder. An example from Jack Drescher is in this article about the World Health Organization classification system:
When ICD-11 is published, being transgender will be listed in a different part of the document, potentially under conditions related to sexual health, said Drescher, who is a New York psychiatrist and a professor of psychiatry at New York Medical College. “So they’ll be diagnoses, but they won’t be mental disorder diagnoses.”
The medical community’s process of de-stigmatizing being transgender was also reflected in the last round of updates to the Diagnostic and Statistical Manual of Mental Disorders in 2013. The DSM, which is used by clinicians, replaced the diagnosis of “gender identity disorder” with “gender dysphoria.” The diagnostic class was also separated from sexual dysfunctions.
Identifying as transgender shares some similarities with anorexia nervosa and body dysmorphic disorder for which treatment consists primarily of therapy and possibly medication. But the regimen for gender dysphoric patients often includes medical interventions to physically alter their bodies to better align with their feelings, making this condition treated like no other mind/body disconnect.
- The popularity of early social transition. It’s becoming increasingly common to socially transition prepubescent children, to encourage them to live as the gender with which they identify. In the Nature article cited above, psychologist Diane Ehrensaft (a proponent of the gender affirmative model) and transgender rights attorney Asaf Orr comment on this approach:
But encouraging children to live as the gender they identify with is an increasingly popular choice. “There’s been a real sea change,” says Diane Ehrensaft, a psychologist at UCSF. She reports seeing more prepubescent patients recently who have already transitioned socially.
Many transgender-rights activists support this model, and liken any other approach to gay-conversion therapy. “You’re telling a kid, ‘I don’t believe you’,” says Asaf Orr, staff attorney at the National Center for Lesbian Rights in San Francisco. The best strategy, he says, is “to affirm a child’s gender exploration, regardless of what the end result is going to be”.
The gender affirmative model encourages children to “explore” their gender identity through social transition. It is often stated that it’s harmless to do so since no hormones or surgeries are involved. But this doesn’t take into account that children who are treated as the opposite sex are being conditioned to continue in their belief, potentially leading to future medical interventions. Even the Dutch researchers who pioneered the use of puberty blockers to treat transgender youth, do not recommend social transitioning in prepubescent children due to the “high rate of remission.”
6. Transactivism. There is a burgeoning group of people who are out to educate the world about the importance of accepting transgenderism. Their pleas are often presented as anti-bullying or anti-discrimination campaigns. They tend to cite high suicide rates and imply that misgendering someone or questioning their gender identity may contribute to these statistics. Many of these activists are transgender themselves and feel they are the most knowledgeable about their condition. They pass themselves off as experts. Many conduct training sessions in schools, police departments, hospitals, etc. They write books, media articles, blog posts. Host conferences. Just one activist can have considerable influence. And there are so many voices shouting this philosophy that it drowns out opposing viewpoints.
7. Framing transgender acceptance as the new civil rights movement. Personally, I was elated when the US Supreme Court declared same-sex marriage legal. But, after that triumph, organizations like the Human Rights Campaign (HRC), the American Civil Liberties Union (ACLU) and the National Center for Lesbian Rights (NCLR) seem to be focusing more intensely on the transgender rights movement.
It is admirable to oppose discrimination against transgender people in employment, housing and appropriate health care. And I very much condemn violence against them. But there needs to be a balance. It should be acknowledged that some impressionable children, teens and young adults are confused and erroneously self-diagnose as transgender. This vulnerable population needs protection from unnecessary medical interventions. But since these organizations promote the “born this way” dogma, anyone who doesn’t blindly accept and support them as the opposite sex, is called misinformed or even abusive and bigoted.
In a short period of time, the transgender rights movement has made substantial gains. There have been laws passed in the United States and Canada that could be interpreted to mean any therapy that doesn’t affirm a youth’s gender identity is illegal. US schools are being pressured to allow transgender-identifying students into opposite sex bathrooms, locker rooms, and even bedroom assignments on overnight field trips. Overall, there has been a tendency in recent guidelines, legislation and court cases to prioritize gender identity over sex.
- The significant growth of the gender industry. There has been a rise in demand for gender clinics, doctors, therapists, endocrinologists, surgeons (and even “packers”—penile prostheses) due to the rapid increase in gender dysphoric children.
Back in January 2016, this pro-transition Cosmopolitan article stated that the first US transgender youth clinic opened in Boston in 2007. And since then 40 more have begun catering—exclusively to children—in the United States.
Surgeons are finding their services are increasingly sought after as well. Dr. Curtis Crane (who performs mastectomies on minors) has commented on how he cannot keep up with the demand for phalloplasties, even though he keeps training more surgeons in the technique:
Crane says he’s one of only a few surgeons in the U.S. performing a high volume of phalloplasties — a booming surgical niche fueled by an increasing number of transgender men seeking to complete their anatomical transition. Even after hiring and training two colleagues to perform the eight-hour surgery, Crane’s patients must wait a year to have it done.
I frequently come across statements from doctors and therapists saying their transgender-based business is flourishing, often with a significant backlog. Due to their expertise, these are the professionals that I wish would speak out about potential over-diagnosis and over-treatment of trans-claiming youth. You have to wonder if they truly see the massive increase in patients as a positive (“more people are finally being treated because they are better informed and there is less stigma”). Or do they see trouble on the horizon (“I’m pretending everything is peachy, but I’m really concerned this may be a disastrous medical trend”)?
- Selective media coverage. Many media outlets portray positive “trans kids” stories, but choose to omit information not favorable to the transgender rights movement. Usually there is no discussion of the high desistence rates, or of the significant risks associated with medical treatments. And when facts like these are not included, the public is misinformed.
US media is chock-full of pro-pediatric-transition stories, many of which have been discussed on this site. You can also click on the Transgender Trend blog links below for examples and excellent analysis of biased programming from the UK’s BBC:
- The silencing of skeptics. Unfortunately, it is taboo to voice concerns that children, teens and young adults may be at risk of unnecessary medical transitions. This blog is one of the ONLY places online that parents and their allies can speak out, although most choose to do so anonymously to maintain their privacy.
Unfortunately, there are some trans activists, deeply offended by anyone contradicting the transgender narrative, who work to discredit anyone who dares to express opposing viewpoints. To these activists, it is fair game to try to get someone fired from their job or to post pictures of their children with sexually explicit captions (see the Michael Bailey link). Alice Dreger, Michael Bailey and Kenneth Zucker have been recipients of this treatment.
On a positive note, I’ve heard there are a growing number of professionals—doctors, nurses, teachers, journalists—whispering their concerns to each other. But due to the current environment, they’re afraid to speak publicly. Afraid they’ll be called bigots. Afraid they’ll lose their jobs.
We are living in a time when the number of gender dysphoric children is rising exponentially with no sign of a leveling off.
Kids are being medically transitioned regardless of the fact that there’s no medical consensus of what the best treatment options are. No one knows the long term consequences of puberty blockers, cross-sex hormones and surgeries in this population. This may very well be a disastrous fad similar to the false memory and ritual abuse scares of the ‘80s and ‘90s. And to top it all off, there’s significant pressure not to publicly express skepticism.
Mainstream media involvement would be welcome, along with brave professionals speaking up about their concerns. It is essential that the public be informed not only of the pros, but also the cons, of transitioning children.
Instead of focusing solely on treating the burgeoning number of gender dysphoric children, professionals ought to investigate the reasons for the radical shift in this population. Why are so many presenting to gender clinics? Why are there currently so many females vs. males seeking treatment (historically it was the opposite)? Why do so many have co-morbid mental health issues—autism spectrum disorders, OCD, ADHD/ADD, depression, etc.? These are important questions in need of answers. Especially because of the often irreversible nature of medical interventions, and that the patients are children with the rest of their lives ahead of them.
Today’s children are exposed to all kinds of influences that weren’t present until relatively recently. It would make sense to now reject the statement “those who identify as transgender in adolescence almost always do so permanently.” And to re-evaluate treatment protocols so that children, teens and young adults receive the thorough mental health care they need, and avoid any unnecessary medical interventions.