Rapid-onset gender dysphoria: New study recruiting parents

UPDATE August 18, 2016: The National Review is reporting this morning that the study was “launched” by 4thWaveNow. While we are very glad to see this research effort take place, the study was initiated and is being carried out by Lisa Littman, MD, MPH at Mt. Sinai in New York. Please see below for details.


Many members of the 4thWaveNow community are parents of teens who became convinced they were the opposite sex after a steady diet of social media and/or peer influence. In most of our cases, the transgender identity came on suddenly and with little warning.

Our families’ experiences haven’t been acknowledged nor reflected in the mainstream media, but now a researcher has decided to systematically investigate the phenomenon.

The survey study is being conducted by Lisa Littman, MD, MPH, Adjunct Assistant Professor, Icahn School of Medicine at Mount Sinai, New York. Dr. Littman’s survey description is below. The SurveyMonkey link at the bottom of this post contains more detailed information.

If you are–or know of–a parent in this situation, please consider participating in the survey. Note that responses are kept anonymous.


Rapid onset gender dysphoria, social media, and peer groups

GCO# 16-1211-00001-01-PD

We have heard from many parents describing that their child had a rapid onset of gender dysphoria in the context of increasing social media use and/or being part of a peer group in which one or multiple friends has developed gender dysphoria and come out as transgender during a similar time frame. Several parents have described situations where entire friend groups became gender dysphoric. This type of presentation is atypical and has not been studied to date.  We feel that this phenomenon needs to be described and studied scientifically.

If your child has had sudden or rapid development of gender dysphoria beginning between the ages of 10 and 21, please consider completing the following online survey. If you have more than one child with gender dysphoria who fits the above description, please complete one survey per child.

This survey is completely anonymous and confidential and conducted through Survey monkey, an independent third- party. There is no way to connect your name with your responses. We do not track email or IP addresses. The survey should take 30-60 minutes. Participation in this research study is voluntary, and you may refuse or quit at any time before completing the survey.

If you know of any individuals with a similar experience who might be eligible for this survey, or any communities where there might be eligible parents, please copy and paste this recruitment notice and survey link to share.

https://www.surveymonkey.com/r/SCX9RZY

Littman ressearch study

In praise of gatekeepers: An interview with a former teen client of TransActive Gender Center

Cari is a 22-year-old woman who previously identified as a trans man. She pursued medical transition at 16, with the support of TransActive Gender Center in Portland, OR. She was on testosterone by the age of 17, and had “top surgery”(double mastectomy) a few years later. Cari says she has been moving towards detransition for over a year now, and started taking concrete steps towards it a couple of months ago, including stopping testosterone.

In this interview, Cari shares her thoughts on transition, parents of trans-identified kids, and her experience with TransActive Gender Center, with a particular emphasis on that organization’s exclusionary focus on medical transition. For gender-dysphoric young people, Cari advocates for greater mental health support, as well as the chance to explore alternatives to hormones and surgery as treatments for gender/sex dysphoria. You can read more of her thoughts on her Tumblr blog.

Cari brings up a number of interesting and controversial points; your comments and questions are encouraged, and Cari is available to respond to them in the comments section of this post.


How old were you when you first began working with TransActive? What brought you there?

I was 16, and I had come out as transgender about a year prior. I found them through a friend who had received therapy there. They were the only gender therapists I could find who offered a sliding scale, which was huge for me since I was paying for my own therapy.

What services did TransActive provide or recommend?

I was given therapy there primarily for the purpose of transition care—getting a referral to an endocrinologist for hormone therapy, and a letter to change the gender marker on my driver’s license. I had been hospitalized about a year prior to starting counseling there due to suicidal ideation and non-suicidal self-harming behavior, but this was not a focus of treatment, other than discussing ways that transition would help with my depression. I was not receiving any other form of counseling for my mental health at the time.

They also recommended their therapy groups and “FreeZone,” which is a social group for trans children, their parents, and TransActive staff, but I didn’t attend those. FreeZone struck me as kind of a weird thing, since it would entail seeing my therapist and probably her other clients in a social setting.

transactive counseling

Did any counselors there attempt to explore whether there might be other underlying issues which could contribute to you claiming a transgender identity? Was there ever a concern that other mental health problems could interfere with a “successful” transition?

My counselor did not explore this with me, other than what seems to be the standard, cursory question of “Would you be able to be happy being a butch lesbian?” or something along those lines. It seems like everyone asks this question, thinking it’s somehow going to help dissuade people who are transitioning for the wrong reasons, but with all the other positive things that are said about transition, it doesn’t really work. I didn’t know that I was a lesbian until after I had started to detransition (primarily due to dating trans men), so this question didn’t strike me as relevant at the time, and there wasn’t any discussion of alternative ways to deal with sex dysphoria. This may simply be because there isn’t much information about alternative treatments in general.

However, I also had an experience there which I believe to be directly negligent on the part of the therapist. During the course of my therapy, before I received a referral for hormones, I began to have trauma flashbacks, which I hadn’t previously remembered. I brought these up to my therapist, and her only response was to devote one or two sessions to it, and then continue with the transition therapy process. This process seemed to be primarily about validating pretty much whatever I said about my gender/planning and mapping out a timeline for my transition, and it was not brought up at any point that prior trauma might have anything to do with dysphoria. The implication that was always present, in therapy or in the other trans-related discussions I was part of, inside and outside of TransActive, was that if I was trans (and my therapist never gave me the impression that I might not be), my options were “transition now, transition later, or live your life unhappy/commit suicide.” To a teenager who is struggling with mental health issues, this is a very attractive proposal: “This is The Cure for all of the emotional pain you’re feeling”.

How did your parent(s) feel about your trans identity? Were they supportive? How do they feel about your decision to detransition?

My parents were supportive of (if a little confused by) my “social transition” (using my male name/pronouns, binding, etc) but thought that I should wait to transition physically until I was over 18.  The staff at TransActive told me I didn’t need their permission for hormones, however, and that they would refer me, so I think eventually my parents may have just gone along with it because they know how stubborn I am.

My parents are supportive of detransition, but told me they wanted me to make sure I was certain about it before “coming out” again. It’s kind of hard to explain that no, your son who used to be your daughter is now your daughter again.

This might be a good place to mention that I pretty recently came to the decision to detransition, so my experiences and opinions are influenced by the rather fluid and unsettled stage of life I’m in right now, and probably not representative of someone who has had more experience living as a detransitioned woman. I can speak as someone who feels that TransActive did not adequately prepare me for transition or present me with alternatives, but I don’t want to try to present my experience as an example of detransitioned women in general, only representative of me, one detransitioning woman.

It seems that many gender specialists, and certainly many activists, are highly critical of attempts to “pathologize” people who identify as transgender. In fact, there is a movement afoot that says attempts to “gatekeep” trans-identified people with other mental illnesses is a form of “ableism.” and that even a person with Down Syndrome or on the autism spectrum should be allowed to medically transition, even as a minor. What are your thoughts on this?

I don’t think that people with comorbid mental illness should necessarily be barred from transition. What I do think is that there should be significant attempts to treat those conditions first, to rule out their involvement in dysphoria. I’m ultimately of the opinion that adults are allowed bodily autonomy, no exceptions, but that if we’re going to medicalize being transgender (which is the basis for having insurance cover it, having it be a protected identity, receiving any kind of special consideration under the law for anything, really), then there needs to be a standard of care that includes ruling out less invasive forms of treatment. It’s not considered best medical practice to jump to major surgery for any other condition, if there’s a reasonable possibility that medication or lifestyle changes could provide the same benefit.

I think that in my case, it’s entirely possible that I would not have been responsive to the idea that transition was not the only means of helping me. I know myself, and how stubborn I am, which I can’t blame TransActive or WPATH or ICATH or the APA or anyone else but myself for. But I do think that they need to be at least exploring these options. If I had been exposed to the idea that transition was not the be-all end-all of treating dysphoria, and that there were other viable options like treating my underlying mental health issues, I would be much more comfortable with their practices. But I wasn’t.

Trans activists vociferously deny that social media/trends could be a factor for some teens wanting to transition, yet it seems obvious to outside observers that the huge increase in girls identifying as trans is at least partly a result of immersion in Tumblr, YouTube, and other online forums. Did “social contagion” play a role in your own identification as trans?

I believe that it’s an oversimplification to blame social media for the increase in early transitioners. I think it has definitely played a role in younger people finding out that transition is a thing they can do, which to my mind isn’t an entirely negative thing—this is the same platform that allows LGBQ youth to connect with others who have similar experiences and find community. I think the increase is probably similar to the increase in teenagers going through a “bisexual phase”—it doesn’t invalidate the experiences of people who really are bisexual and discovered this in their teens, but it does mean that with the increased visibility of LGBQ people, that there is a higher incidence of teenagers questioning their sexuality. Now, with information about transition being readily available online, and a growing community of trans people to connect with, more young people are questioning their gender. The only difference being, questioning your orientation doesn’t make you want to pursue permanent medical interventions to your body, and it isn’t posited as a necessity for an LGBQ person.

To answer the question that you actually asked, though, online forums did play a significant part in my decision to come out as trans. I wasn’t so much into YouTube, though, and this was before Tumblr was a popular site. However, once I actually did come out, many, if not most of my formative interactions with the trans community (i.e., ones that influenced my decision to transition) were in-person ones, either through support groups or social events or LGBTQ youth spaces.

You no longer identify as transgender. What was your process of deciding this wasn’t right for you?

Actually, this is kind of funny, since your last question was about social media influencing people to transition. My decision to detransition was largely informed by social media, Tumblr in particular. Not that the detransition community, such as it is, convinced me to do so; my interactions with other detransitioned women have been limited since it wasn’t until recently that I stopped just reading and actually started interacting. But in the short time I have been communicating with other detransitioned women, I haven’t really ever felt any kind of pressure from them to do something particular about my transition, or to subscribe to any particular ideology. Rather, my experiences of reading the writings of detransitioned women were influential to me because they gave me what organizations like TransActive never did: images of women who had experienced the same things I had, who had struggled with dysphoria, and had found methods of making peace with their bodies in a way that I was starting to realize transition never would for me. Transition was very helpful for me in a lot of ways, and I wouldn’t say that I regret my decisions, but at some point it just ceased to be helpful to me. I think it helped me to be comfortable with my body and at some point I realized I was comfortable enough that I could stop, that I was ready to recognize myself as female again.

Do you believe some kids or teens are “truly trans”? Do you think gender identity is innate or “baked in” at birth? And if so, what differentiates true trans from people who thought they were trans, but eventually decide to detransition?

I think the scariest thing for me in my decision to detransition is that I haven’t really seen a whole lot to differentiate people who transition and are content, and people who transition and realize they made a mistake. I’ve seen people who checked all the “true trans” boxes, who were “transmedicalists” or believed themselves to be “just men with a medical condition,” who later detransitioned, or reidentified with their sex, or at the very least expressed serious doubts about their own motivations for transition, whether they pursued those doubts or not. I’ve also seen people who really didn’t seem to check those boxes, who had been transitioned for years and were still very happy with their decisions. I’d like to say that I know exactly how to tell the difference between the people who will end up happy with their transitions, and those who realize it isn’t the right choice for them, but the truth is I don’t. I think that all we can really do is to ensure that there are attempts being made to present all options, and to rule out other issues that might need to be treated first.

I also think that there are people for whom transition is the best choice, or at least the best choice they could have made under the circumstances. I’m coming to terms with the idea that I really just don’t have conclusive answers, that it doesn’t seem like anyone does, and that perhaps the best we can do in these situations is to try to make peace with our bodies as best we can. That perhaps there just aren’t any easy, unambiguous, black-and-white answers about why people are dysphoric or whether transition is the right choice for them. That’s what I wish organizations like TransActive would embrace–not “this is your only choice,” not “this is not a viable choice at all,” but instead, “we don’t have all the answers, but here’s what we know about your options.”

Partly due to lobbying by TransActive and its director, Jenn Burleton, the state of Oregon now permits trans-identified teens as young as 15 to obtain surgeries (including mastectomies and hysterectomies) without parental consent. TransActive is networking with activists and lawyers in other states to push for lowering the age of medical consent nationwide. Given your own experiences, do you think there should be a minimum age for medical intervention for trans-identified people? What age is appropriate to begin cross-sex hormones? To receive “top surgery?” To undergo bottom surgery and/or hysterectomy?

I think the idea of someone being able to get transitional surgery underage is concerning—in the state of Oregon, you can’t get a tattoo underage even with parental consent, but you can be permanently sterilized at 15 without any parental input. This is built off the law that minors 15 and older can consent to their own medical and dental diagnosis and treatment, up to and including surgery, but it seems to me that these kinds of surgeries are things that can wait until someone is at least 18. You can’t diagnose many mental disorders, such as personality disorders (which I have personally seen as a contributing factor in people incorrectly thinking they are trans) until the age of 18, and it seems reasonable to me that permanent surgical interventions for what is arguably a psychiatric issue be held off on until that age. I don’t know what I think about underage hormone treatment, but I lean towards the idea that it should be available, but that again, proper alternative treatment and safeguards need to be in place, that it needs to not be the sole focus of treatment or option presented.

What advice would you have for parents who are concerned about the seeming trend in kids identifying as trans? There is very little support for parents who don’t simply go along with their child’s announcement.

I think it can be a very delicate thing, as I’m sure you know. Children and teens who are questioning their gender are usually in a very vulnerable state. I think they often feel that the people around them can’t understand what they’re going through, and that leads to feeing very alone and isolated. I know I felt that way, and when I encountered resistance to my transition, it really made me feel that interacting with those people was unsafe or that they felt contempt or condescension for me and for what I was feeling. I did cut off or restrict contact with a lot of people due to them not supporting my transition.

So I think it is of the utmost importance that parents go about it with a lot of respect for their kids and validation that what they are going through is an incredibly difficult and painful state, without that necessarily meaning you’ll go along with their desires unquestioningly. I think it’s possible to have a child-centered process without it being all about transition. Brainstorm with them about what they might be able to do to help them cope with their dysphoria, support them in going to therapy, but suggest that they examine other modes of treatment in therapy before seeking transition, things like that. Try to make yourself a safe and supportive person for them to trust with their feelings—this not only allows you to make suggestions to them and discover their underlying feelings and motivations for transition, but also means that they might not be as scared to say, “hey, I think I might have made a mistake/I have these questions and the community isn’t answering them.” Knowing that my parents supported me making my own choices and weren’t about to say “I told you so” was a huge factor for me in feeling comfortable when I told them about my decision to detransition

That said, I think it’s entirely reasonable to set the boundary that you aren’t comfortable allowing them to medically transition while underage. As my parents explained it, once you’re 18, you can make whatever decisions you want, but this is something that you should take responsibility for as an adult person, rather than us signing off on it for you. Of course, this didn’t end up working for me, since I lived in Oregon, a state that allowed underage consent to transition. But regardless of that, I think it was a good thought for them to have and express.

Do you think parents should buy binders for their daughters who identify as trans men? Some parents feel it amounts to a “slippery slope” that may lead to their child seeking top surgery.

I don’t know that I think a parent “should” give their kid anything other than, you know, the things any parent should give that have nothing to do with gender identity–food, clothes, medicine, age-appropriate activities, an allowance if you can afford it, etc. I always bought my own binders, and paid for my testosterone prescriptions even when my parents were paying all my other medical expenses. I do think it’s invasive that a lot of parents will cut up their children’s binders or confiscate them. I think if a kid buys something for themselves that’s helping them cope and not making permanent unhealthy changes to their body, then it should be tolerated.  Doing something like taking a binder away is really only going to deepen the distrust the kid might have. Obviously if they’re binding with Ace bandages or tape or something, that should be discouraged, but I don’t see an issue with a teenager having a safe means to bind. As to whether it’s a “slippery slope,” I suppose it’s possible. I think I would say the same thing about letting your child bind as I would about anything transition-related: I don’t think it’s right to bar your kid from expressing themselves or exploring their identity, but that the more important factor is making sure they have proper information and resources, including the ways they could cope with their body without these interventions, and ideally, role models who have found a variety of ways of to cope with their gender nonconformity and/or dysphoria.

Suicide risk is often given as the main reason children and teens should be “affirmed” in their trans identity. What do you think about that?

I think it’s something to approach with caution. Suicide risk is a good reason to treat a lot of mental disorders and medical conditions, and I think the fact that gender dysphoria is one of those disorders is not necessarily cause for alarm. Someone being a suicide risk without psychiatric medications is a good reason to give them psychiatric medications, someone being a suicide risk because of neuropathic pain, which isn’t likely to physically kill you, is a good reason to give them pain medicine. Someone being a suicide risk due to feeling disconnected from their physical sex can, I believe, be a good reason to give them cross-sex hormones and surgeries, provided other courses of action have been examined in an objective way, and having really looked at those other options, medical transition still seems to be the best choice.

What I think is more concerning is the trans community’s tendency to present suicide as basically the only alternative to transition, and to martyr trans individuals who do commit suicide, as I think we saw pretty strikingly in the case of Leelah Alcorn.

Trans activists decry “gatekeeping,” with the current trend moving towards “informed consent,” trust in self identification, and earlier and earlier medical intervention, even for children. Do you agree with this trend? Why or why not?

I think this has been pretty well addressed with my answers to other questions, but to make it explicit, my opinion is that gatekeeping is absolutely necessary. Denying someone any kind of care for their issues is medical neglect. Forcibly trying to change someone’s mind about being trans is medical abuse. Showing someone all available options, following a standard of care that takes all of them into account, and ruling out a differential diagnosis that could be treated without permanent bodily alterations, is neither of those; it’s just part of providing good healthcare.

There has been some tension between gender critics—especially gender-critical feminists—and women who have detransitioned. I have read that some detransitioned women feel they are used by feminists to make a point that all transition is harmful. Quite a few detransitioned women write that self hatred and/or internalized misogyny or homophobia were factors leading them to transition in the first place, but when these same factors are pointed out by gender critical feminists, detransitioned women sometimes object. I wonder how much of the tension is down to a generation gap? Some Second Wave feminists who experienced gender dysphoria as children believe that if medical transition had been available at the time, they’d have jumped at the chance and likely been diagnosed as trans. On a political level, if detransitioned women and gender critics could unite, they could have the potential to make important changes in how children/teens are currently treated. How can this rift between gender critics and detransitioned people be healed?

I believe you included this question to address my stated uncertainty about doing this interview, due to my experiences being co-opted by radical feminists in the past. However, my experience of this happening was while I was still in transition, so I don’t have personal experience of what you’re describing.

From what I’ve seen, I think a lot of the backlash from detransitioned women has to do with the, honestly, very unkind and insensitive way that some radical feminists talk about transition—saying that trans people are “delusional,” that transitioned/detransitioned people are “mutilated,” etc. Whether or not transition is a good idea (for anyone), this kind of attitude really trivializes the emotional pain, the social struggle, and the complicated and messy ways in which people come to the decision to make these changes to their bodies. In my own case, I believe I made the best choice I could, given the options I was presented with. I don’t appreciate being called “mutilated” for doing what I felt I had to in order to survive.

I think it’s really great that radical feminism focuses on the social roots of these issues and doesn’t just go with whatever choices people feel like making without examining them critically. But I also think that sometimes can lead to a lack of compassion for the people who make those choices, and a lack of allowance for nuance and grey area around how people interact with and cope with their social realities regarding gender. I don’t have a concrete answer for you about how radical feminists can ally themselves with detransitioning women, but I think it has to start with a good hard look at the way these issues are talked about, to make sure that we’re having these discussions in a way that shows empathy for the people who are affected by this, whether they’re questioning or transitioning or transitioned or detransitioned

How are you doing now? Have you received any support from doctors or therapists/counselors for your detransition? Does TransActive provide any services for people who change their minds?

By the time I decided to detransition, I was not receiving gender identity-related therapy. However, my current therapist knows of my detransition, and is fully supportive of it. In fact, he told me he would not have signed off on my transition if he had been my therapist when I was transitioning, given what I’ve told him of my circumstances.

TransActive does not, to my knowledge, provide any services for transgender adults, so I wouldn’t expect them to provide anything for detransitioning adults. (I’ve recently contacted TransActive asking if they have any services/could refer a detransitioning person to services, and will update this response once they reply).

Do No Harm: An interview with the founder of Youth Trans Critical Professionals

A new organization has formed for therapists, social workers, medical doctors, educators, and other professionals concerned about the rise in transgender diagnoses among children, adolescents, and young adults. Youth Trans Critical Professionals was founded by a psychotherapist and a university professor just a few short weeks ago. The organization has a website (already publishing thought-provoking pieces from professionals), a Facebook page, a Twitter account, and many followers. If you are a professional skeptical of the transgender youth trend, please visit the website and consider contributing to the effort. Your anonymity will be protected at your request.

4thWaveNow recently interviewed one of the founders of Youth Trans Critical Professionals. She is available to respond to your questions and remarks in the comments section below this post.

ytcp logo.png

Why did you start this organization for professionals skeptical of the trans-kid trend? What is your personal interest in this matter?

I’m going to start by saying something that I will probably say several times. Our main concern is with medical intervention in children and young people that leaves their bodies permanently altered and/or sterilized. We don’t have a moral issue with people identifying as transgender, and believe that those who do should be protected from discrimination like any other minority. However, the medical treatments for children who identify as transgender are risky, not approved by the FDA, and permanent. With any other condition, we would be bending over backwards to find other ways to support these children without resorting to major medical intervention, and would turn to puberty blockers, cross-sex hormones, and surgery in only the rarest and most extreme cases. It is very disturbing to the originators of youthtranscriticalprofessionals.org that these treatments, whose long term effects are not well-studied, are being offered very casually for a condition which isn’t even clearly defined.

I have a private practice where I work mostly with adults, although from time to time, I do see adolescents. I first became aware of this issue because parents were coming in describing kids struggling with gender identity. I started to notice a pattern: an anxious, depressed, or socially awkward kid who spent a lot of time on social media would announce that he or she was “trans,” often requesting access to cross-sex hormones shortly after this announcement. Every one of the mothers in my practice who reported this behavior was incredibly supportive of her child. These moms may have shared feelings of confusion or concern with me, but their initial reaction toward their child was always acceptance.

The first time I heard this story, I didn’t make much of it. It sounded like normal teenage experimentation to me, and I admired the mom’s openness to accepting her child. However, as I saw more of these cases – and I saw the cases progress to the point where the child was demanding medical intervention – I became concerned and wanted to learn more.

What I found once I started looking was that more and more young people are identifying as trans, often after bingeing on social media. For some reason that I can’t quite fathom, there is a tremendous feeling of excitement around this issue among many adults. I found out that administrators at private schools were boasting about “several kids transitioning” at their school. I heard this from more than one school while I was researching this. They shared this as evidence, I think, of how truly progressive and accepting their school is. However, I find it really odd that no one blinks an eye when four kids are transitioning in a grade of sixty kids. Given how rare transsexualism is believed to be, doesn’t that alone ring a warning bell?

The more I learned, the more disturbed I became. Where were the critical voices? Where were the adults familiar with child development speaking out for young people who are in danger of being swept along on a current that may carry them towards sterility before they have even finished high school?

I was shocked to realize that many of my fellow therapists appear to have uncritically bought into the narrative about trans children that goes something like this: 1.) gender identity is a legitimate thing. You cannot question it without being bigoted. 2.) Children know their own gender identity. 3.) If you do not immediately and uncritically affirm a child’s professed gender identity, you will be doing that child grave harm, and may even induce suicidal behavior, 4.)  The best and only treatment for a child who professes to have gender dysphoria or claims to have a gender identity other than that associated with his or her sexed body is transition – social, medical, or both. It doesn’t matter whether that child has comorbid mental health issues such as anxiety, depression, trauma, autism, substance abuse or bipolar disorder. 5.) Once a child has professed his or her gender identity, the adults around that child should follow his or her lead, providing whatever treatment and accommodations are requested by that child.

There is nothing about the narrative outlined above that is beyond controversy and shouldn’t be open to questioning. The construct of gender identity is poorly defined and lacks coherence. It surely shouldn’t be the basis for subjecting our kids to irrevocable body changes and sterilization. Assuming that children have some mysterious knowing about their gender identity seems like poor practice. Children are often very sure of things at one moment in time and believe something completely different a week, a month, or a year later. Child development is a fluid process. Refraining from immediately affirming a child’s gender identity brings with it no documented harm. The oft-quoted figure about suicide among transgender youth is a misuse of statistics. Many children (and adults, for that matter) feel significant distress about an aspect of their body or identity. Usually, therapists explore many ways to support a person facing this kind of discomfort. Sometimes medication can bring relief. Sometimes, exploration brings a new understanding. Sometimes, discomfort must be borne as we come to terms with a difficult or disappointing reality. Why the rush to change the body? Permanently?! Of course we as adults should be putting the brakes on a process that is leading toward permanent sterilization. Of course we should. Where were the other professionals who also believed this?

There is such a dearth of professional voices calling for restraint and caution in turning to medical intervention. Pediatricians, social workers, psychologists – most professional groups state that we must affirm a child’s gender identity. While we appreciate the intention here to be supportive of gender non-conforming kids, it seems the greater value ought to be protecting children from unnecessary medical procedures that often result in sterility; a central aim of youthtranscriticalprofessionals.org is to raise awareness of this.

Yes. Where are the child and developmental psychologists on all of this?  Much of what transgender activists promote seems to fly in the face of what we know about child and adolescent developmental psychology. It has been understood for decades that young children confuse fantasy with reality; that adolescents try on and shed different identities;  that children are conditioned by what they experience; that a child or adolescent’s sense of self is anything but rigid. Have you heard from any skeptical child psychs, and what will it take for some of them to start speaking out?

So far, I haven’t heard from any, but I imagine we will. You are right, and you phrase the issues very clearly. Kids do try on different identities. And we as adults don’t do them any service by privileging gender identity as some special, separate category. There is nothing innate or special or sacred about gender.

And kids have very strong feelings about what they want, and they often confuse things they want with things they need. It is so incredibly difficult to watch out child be in psychic pain. It can send us flying into action as we try to make their suffering stop. But part of our job as a parent is to use our discernment as the adult who knows them best to learn when to listen to the manifest story they are telling us about themselves, and when to listen to a deeper story underneath that.

I was talking recently with a friend who has a daughter in college. She was telling me about the awful, awful time she went through when he daughter was 13. The girl was obsessed with getting an iPhone. She cried nightly about how terrible it was for her not to have one, how it was damaging her social life and making her isolated and depressed. She was visibly distraught over this issue being any reasoning. She begged for it literally as if her life depended on it.

Thinking of this issue with trans kids, I said to her, “At least you knew that she wasn’t going to come to any grave harm if you didn’t give her an iPhone.”

My friend surprised me by saying that at the time, she felt confused about whether she was doing great harm to her daughter by not giving her a phone. “Between the peer pressure and the advertising, I was almost convinced that I was doing her grave psychological damage.” Imagine how hard it would be to stand up to a teen’s desperate demands for hormones if you had mental health professionals telling you that you were damaging your child by withholding them!

I suppose the point is that just because our kids want something very, very badly doesn’t mean that we have to capitulate or surrender our adult judgment. Teenagers don’t have a fully developed prefrontal cortex. We can’t abdicate our responsibility as their parent to say no when what they fervently desire may be harmful for them, or at least may have consequences they aren’t capable of fully appreciating.

Do you believe there are truly transgender children? Are they different from the teens who claim to be trans because of social contagion?

What a complicated question! Let me break it into a couple of parts.

First of all, there is no question that there has been a huge increase in kids identifying as trans. Much of this increase is certainly due to social contagion. Kids are getting exposed to this on social media, where they are taught that “if they are asking whether they are trans, they probably are.” Look, most teenagers go through a period of feeling intensely uncomfortable in their own bodies. I think that for many of these kids, this is an expression of that discomfort. Forty years ago, maybe more kids developed eating disorders. Twenty years ago, they were cutting. This is the current way to express that nearly universal adolescent discomfort. We all need to feel that we fit in, and that we stand out. Identifying as trans hits both of those criteria big time. You go to school and announce you are now Joe instead of Jo, and let people know you want to be referred to by a different pronoun, and in many schools, you are met with excited acclimation from peers. You are different in an exciting, trendy way. At the same time, you can feel a part of the other kids who are also embracing different gender identities. It must be very heady.

So I do believe that there is a huge social contagion piece, and this is one of the things that I don’t hear other people talking about much. This matters a great deal, because it has probably happened that some anxious, socially awkward kid has come out as trans as a way of gaining acceptance and belonging, and has gotten so much support and affirmation that she has continued down the road to take hormones. In short order, she had permanently altered her body – a deepened voice, facial hair, baldness, increased risk for certain diseases – and maybe this wasn’t for her, really? Or not for her forever? But now this person has to live with those consequences forever. Testosterone and other cross-sex hormones are not tattoos that carry trivial risks, or can at least be hidden easily. This ought not to be a life-style or fashion decision, and for some kids at least, I am convinced it is. I realize this is an incredibly unpopular stance, but this is what I am seeing from my little perch.

Of course, there are those who identified significant distress with the sex of their body before transgenderism became a cause celebre. I have read the stories about two-year-olds who ask why God made a mistake. Some of these stories are pretty compelling. I am not an expert in this area, and when I read these stories, my strongest reaction is that I am grateful I have never had to be the person responsible for making a decision about such a case. I’m not at all sure what the right thing to do is, but I will say that I could imagine that transitioning might be right in some cases.

There is an Atlantic article about this from 2008 that I found very interesting. It profiled several of these kids who are “persistent, insistent, and consistent” starting at an early age. Some of the Canadian kids were treated by Dr. Kenneth Zucker. The article describes some of the things involved in the treatment such as “taking all the girl toys away.” I admit that made me cringe. Really?! Who would want to do that to their child? However, at the time the article was written, Chris, the child in question, had grown up to be a gay, effeminate man who had a healthy, intervention-free body.

My understanding is that when Zucker’s team assessed a gender dysphoric child, they closely examined the family system, considering carefully different dynamics that were in play, and then crafting an individualized treatment plan that might involve several different kinds of interventions. I believe that enforcing gendered toys was something that was done in some cases, but was accompanied by other therapeutic interventions that took into account the whole family dynamic. The ultimate aim was to help the child feel comfortable identifying with his or her natal sex.

The article also followed an American child who had been affirmed early, and had begun to live as a girl. And it made reference to the social media star Jazz Jennings, who was profiled by Barbara Walters. I found the reaction of the Canadian parents to this practice of early affirmation very compelling, so let me quote from that part of the article. (The bolding is my own.)

The week before I arrived in Toronto, the Barbara Walters special about Jazz had been re-aired, and both sets of parents had seen it. “I was aghast,” said John’s mother. “It really affected us to see this poor little peanut, and her parents just going to the teacher and saying ‘He is a “she” now.’ Why would you assume a 4-year-old would understand the ramifications of that?”

“We were shocked,” Chris’s father said. “They gave up on their kid too early. Regardless of our beliefs and our values, you look at Chris, and you look at these kids, and they have to go through a sex-change operation and they’ll never look right and they’ll never have a normal life. Look at Chris’s chance for a happy, decent life, and look at theirs. Seeing those kids, it just broke our hearts.”

So I think, if I had a little boy who insisted he were a girl, and I could do this terrible thing of enforcing gendered play, or I could do this terrible thing of altering his body and destroying his ability to have his own children, which would I pick? If I knew I would have a healthy, happy, whole gay man at the end of it, if I had a reasonably good guarantee that would be the outcome, I would much rather pack away the Barbies. The personal and social difficulties of back-tracking on a childhood or adolescence spent transitioning will inevitably be immense. If a child has been transitioned from a young age how will they know, or be able to begin to articulate, that a mistake has been made? At a recent at Cambridge University seminar entitled ‘Gender Non-Conforming Children: Treatment Dilemmas In Puberty Suppression‘ it was stated that 100% of children on puberty blockers go on to transition; it’s clear there is absolutely no going back on medical intervention.

In any case, those of us who started youthtranscriticalprofessionals.org would argue that transition is always an option into adulthood. I am familiar with the view that when someone transitions as a child, they have a better chance of “passing” in adulthood, but given the very real risk of later regret, I think we might decide that medical transition is a choice to be made by full-fledged adults only.

How do you answer charges that you are promoting harmful reparative therapy on trans youth? How is this different from trying to turn gay kids straight?

Well, I’m not sure I believe that we should try to “talk kids out” of believing that they are trans, first of all. If a fourteen year old kid came into my office and said, “I’m pretty sure I’m gay,” or “I am gay,” I would say, “Tell me about that! What is that like for you? How long have you known? What lead you to first wonder about your sexual orientation? What is hard for you about knowing this? What kind of support do you need?”

If a fourteen year old kid came into my office and said, “I think I am trans,” or “I am trans,” I would ask similar questions: “Tell me more about that? What does that mean to you? Help me understand your internal experience that leads you to know yourself as trans? What kind of support would be helpful in addressing this? When did you first start to wonder?”

The purpose is both cases would be to do the thing that therapy is meant to do – to explore our experience so that we can understand it more deeply.

There are a couple of differences. First, while I would be interested in hearing from the gay child about his particular way of experiencing his gayness, we all have a pretty clear idea of what that means. A gay boy experiences sexual attraction to other boys, and not so much with girls.

The notion of gender identity, however, is much less clear. If a boy of fourteen were to tell me he is really a girl, I would want to know about that experience. What does that mean? In what way do you experience this inner sense of femaleness? How does this experience manifest for you? What are the different ways of understanding this experience? Is it a consistent experience, or is it subject to variation? How does this experience influence your understanding of yourself?

Sexual orientation and gender identity are actually quite different and these differences justify different approaches. Sexual orientation has shown itself to be quite stable. Most gays and lesbians knew from very early on that something was different. These feelings aren’t dysphoric, although they may cause distress because of homophobia. It isn’t dysphoria, it is just an awareness of who you are. It isn’t a sense of being wrong, or in the wrong body. And it doesn’t tend to change. These feelings are generally stable throughout the life span.

This isn’t the case for gender dysphoric kids. We know that a majority of them will naturally desist. Unlike sexual orientation, gender identification does tend to change for the large majority of dysphoric kids.

The other major difference – and this is the heart of the artichoke – is intervention. Gays and lesbians are not seeking intervention. They just want to love whom they love. My hypothetical gay boy client and I would be free to discuss and explore his experience of being gay and his coming out process without any high stakes medical decisions hanging over our heads. If I knew that my hypothetical trans patient would not have access to medical intervention until she was, say, 25 years old, she and I could spend our therapeutic hours exploring her experience as a trans woman, and I could offer support for the difficulties involved in being different in this way.

My goal for therapy with a trans kid would be to provide a warm, judgment free space in which they could explore their gender identity and what it means for them without a rush to medical intervention. I wouldn’t aim to convert. No. But I wouldn’t want to close in on this being the final answer, since I know that so many gender dysphoric kids will desist of their own accord.

I would hope that no one would ever be shamed or persecuted or made to feel unworthy or respect and love because of these feelings. I would argue that there is another approach in between rejection and affirmation, and possibly the word for that would be acceptance. I accept you as you are. I support you. I am curious about what you are going through. I want to hear more about your experience. And I accept that your sense of your own identity might change, and I will accept you then as well. But in any case, I would hope to delay medical intervention until the person was at least 25 years old.

Maybe the last thing to say about this is the most controversial. It isn’t really clear what exactly “gender identity” even means. It appears to refer to a subjective inner state, but when pressed, those who identify as trans will often resort to gender stereotypes in describing their discomfort. Forgive me, but I am not going to want to send any person down a conveyor belt toward permanent mutilation and sterilization over a self-diagnosis of an inner state.

Gender is a social construct. If gender is the problem, why on earth change the body? Is seems obvious that the right thing to do is to change or even abolish the construct altogether. Changing the body to fit the social constructs we have around gender only serves to further entrench the constructs we are trying to escape – and these are socially, not biologically constructed; there is no evidence that gender identity is innate.

What is your vision for Youth Trans Critical Professionals? What do you ultimately hope to achieve?

Initially, we are hoping to solicit posts from 100 professionals writing on the trans child trend from how they see it. By doing this we aim to assemble the first collection of voices of Youth Trans Critical Professionals to evidence our mutual concern. There is a meeting being planned, and we are also discussing the possibility of co-authoring a book. Ideally, we would like to help move the needle on this conversation, hopefully resulting in clearer standards of care that protect gender dysphoric and nonconforming young people from unnecessary medical intervention and permanent sterilization.

How can a group of anonymous professionals make a difference? Without a public face and voice, who will believe you are who you say you are?

Anonymity certainly limits our credibility at this point. Many of us are contending with constraints of professional institutions which broker no dissenting views. It is our hope to speak out publicly once there are more of us. In the meantime, I hope that we will be judged by how we write and think. I believe that people that read the site will know that we are striving to do this in order to protect children from unnecessary medical procedures and permanent sterilization, not out of hatred or bigotry. In addition, some professionals working with us are also friends and relations of children and young people identifying as trans and need to remain anonymous to protect their loved one’s privacy.

In the few weeks the site has been live, have you heard from other professionals who want to be on-board?

The site has been up for less than two weeks, and it has already been viewed over 2,000 times. The overwhelming majority of the comments have been positive. (I have not deleted any comments, if that tells you anything. One person wrote a critical comment, which I approved.) And yes, professionals are reaching out and asking how they can be involved not just from professions allied to medicine, but teachers, youth workers, practitioners of law, artists and writers and so on.

How can parents find therapists and other medical providers who will resist the current trend to diagnose kids as trans? There are no public directories, while there are tons of  published resource lists of “gender specialists.”

What a good idea! Perhaps we could gather the names of such providers and maintain a directory. This would be a great resource because families are telling us they reluctant to access services because they do not trust service providers to tread a sensitive line between gender confusion and medical intervention.

As a therapist, how would you suggest a parent deal with a child insisting they are trans? The current trend seems to be “affirming” the child’s identity, no matter how old the child is.

Well, this is another complicated question. Obviously, we always want to communicate love and acceptance of our children. We can accept and affirm our child and respect their struggles and personhood without necessarily affirming a professed identity.

Part of what makes this a thorny problem is that there is no neutral stance. If we affirm the kid’s gender identity, we likely tip the scales in favor of a trans identity. If we look for other ways to express our support and empathy for our child, we likely tip the scales the other way. Given that even doing nothing is not a neutral intervention, we have to ask a difficult question. Is desistance a better outcome? If we had to choose which way to tip things, what is the right way? For me, it is clear that, all things being equal, desistance is a better outcome because it avoids invasive medical procedures and sterilization. Whenever a young person is engaged in keeping the conversation about their trans identity open, they may feel comfortable deferring medical intervention which will have the side effects of irreversible sterilization – at least this puts growing maturity on their side.

There is also the very critical issue of social contagion. I believe that many kids identifying as trans for the first time as teens – and perhaps many younger kids as well – have “picked this up” from social media. Parents are not infallible, but we are likely the best judges of whether our kid is truly suffering from deep-seated gender dysphoria, of whether the gender issue is a way to express other issues.

If a parent has a teen who comes out as trans, I would be interested in knowing the following:

  • Has the child been anxious, depressed, or struggling socially?
  • Does the child have other mental health issues, such as PTSD, substance use, or bipolar disorder?
  • Has the child been spending a lot of time on social media? What sites? How much time?
  • Are the child’s peers (or desired peers) coming out as trans as well?
  • Did the announcement come “out of the blue,” without prior indication that the young person has ever struggled with their gender or identity before?

If the answers to these questions are pretty much “yes,” I would actually suggest that the parent state firmly and clearly that they do not support their child’s transition. I realize this is heresy. I would, as David Schwartz suggests, stop talking about gender. Anxious and depressed teenagers may learn that they can get a rise and a reaction out of adults when they mention gender. Addressing only the gender dysphoria instead of the underlying issues does these kids a huge disservice.

We know that social media sites like Tumblr and Reddit are fertile ground for social contagion and that many children start talking trans following immersion in these worlds. We know it’s easier said than done, but disconnecting them from the internet, especially social media, does give space for developing more self-reliant thinking. For some families it may be possible to remove a young person from their environment completely. Three months spent in nature away from screens, or overseas, or volunteering in a challenging environment may serve as a “hard reset,” allowing them to focus on something other than themselves. (After all, gender dysphoria is in essence very solipsistic.) Of course not all families have the networks or necessary resources to broker new horizons for their child in these ways. Parents are telling us it is extremely difficult to work out the best ways to support their child. But we are gaining increased confidence that saying ‘no’ to your child’s trans aspirations can inspire your child’s confidence for reflection. All parents try to keep their children away from dangerous trends sweeping youth culture and the trans trend requires the same vigilance.

I do believe that parents can have an impact. Letting a kid know that you don’t buy the gender identity drama, stating plainly that you love them as they are, but you don’t want to see them destroy their health and sterility can have an impact. They might roll their eyes, but I believe they hear you. At least if they ever look back in regret and despair they will know that you tried to protect them.

How can we support you?

If you know a lawyer, doctor, therapist, academic, nurse, teacher, guidance counselor or other professional who deals with young people and questions this trend and is thoughtful, please send them to our website! We are hoping to solicit 100 professionals to post on the site over the next few months. They can reach us from the site, and can send us material to post – anonymously if they wish.

Send parents, trans youth and their allies to the site too. Our aim is to cohere strength amongst and between us to bring serious, committed and critical attention to the dangers of trans orthodoxy.

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.

 

Guest post: For teen girls with autistic traits — a plea for watchful waiting

This guest post by 4thWaveNow community member neverfallingforit is second in a series exploring the increasingly well known connection between autism spectrum disorder (ASD) and gender dysphoria (or other gender-related issues).

 Many of us have shared observations that our kids show signs of ASD. Unfortunately, the current treatment paradigm tends to view ASD as no barrier to “transitioning” kids and young adults.

 A word about the title of this post. The current approach fostered by WPATH is generally referred to as “watchful waiting” with regard to diagnosing younger children as transgender. While this sounds like a hands-off approach, in reality “watchful waiting,” to trans activists and many gender specialists,  often includes the use of “preferred pronouns,” “social transition,” and (frequently) puberty blockers. Once these kids reach adolescence, “watchful waiting” ends and the path to full medical transition becomes available.

There is much that is still unexplored (and unstudied) about the impact of these supposedly benign interventions on actually helping to create a persistent transgender identity in children and young people. I’ll have more to say about this in a future post.


by neverfallingforit

When my daughter first started identifying as transgender, I quickly and easily found articles online which posed a link between autism and gender identity issues. I bought the books Aspergirls by Rudy Simone and I am Aspiengirl by Tania A Marshall. At the back of each book there is a checklist of traits for girls with Asperger Syndrome, many of which I learned were different from those which appear in the male Asperger profile.

146 cropped small

I also learned that formal research on the autistic female profile is relatively new, and as such, is years behind clinical and anecdotal observations. After reading the books, my daughter herself placed ticks next to a whole host of these traits, and I began to suspect that an autistic spectrum disorder (ASD) was in the mix here somewhere. Several traits particularly jumped out at me:

  • may have androgynous traits despite an outwardly feminine appearance. Thinks of herself as half-male/half-female (well balanced anima/animus)
  • may not have a strong sense of identity and can be very chameleon-like, especially before diagnosis
  •  will not have many girlfriends and will not do “girly” things like shopping with them or have get-togethers to “hang out”
  •  emotionally immature and emotionally sensitive
  •  strong sensory issues – sounds, sights, smells, touch and prone to overload
  •  will have obsessions but they are not as unusual as her male counterpart (less likely to be a “trainspotter”)

After finding 4thWaveNow, I read that gender identity clinics are seeing a higher number of natal girls in their referrals than they would expect from previous epidemiological knowledge, and also that it is very common to find that these girls had autism spectrum characteristics. Some of the studies alluded to the fact that cultural factors could also be at play in the increasing referral rates.

As I read the comments on many of 4thWaveNow’s posts, I could see a profile emerging of a subset of teenage girls who had come to believe that they were born in the wrong body. Most had never previously mentioned gender dysphoric feelings to their parents, although many had never been “girly girls.” They often seem to share the same personality traits; traits which fitted right into the female Asperger profile. 4thWaves’s comprehensive article on autism discusses how autistic spectrum traits could lead to a transgender presentation and I could clearly see how this applied to my daughter.

What really caught my attention was how these girls also seemed to share the same cultural traits. My parental antennae kicked in.

147 cropped small

Then, I found an article on GenderTrender, and some more pennies began to drop. Way back in 2010, that blog was insightfully covering the transgender trend in ‘tween and teenage girls

 who believe that rejection of increasingly constrictive female norms means they must be male. These girls don’t want to act out a ‘female’ role in relationships with boys.

Here was an apt description of my daughter, who kept telling me that she must be a boy because she was a “rubbish girl,” that she wanted “to be the boy in the relationship, saying the lines and making the moves.”

She and her friends had recently been watching porn videos on their phones at school, and a letter had been sent home to parents. I wondered if the images she had seen had frightened her. Girls with ASD often have sensory issues which can mean they don’t like to be touched much, or hugged; a few in my daughter’s online social group describe themselves as asexual. Maybe she felt that taking on a male presentation would ensure that she wasn’t pressured into situations which she was uncomfortable with? She refuses to discuss it with me.

As the same article also observed,

 they don’t want to be marginalized as the gender non-conforming women that they are. Femininity rejecting females simply DO NOT EXIST in the media reflection that is so important to children and teens in western culture. These kids want to fit into social norms, wear the right brands, get the right haircuts, and look like the people in magazines. “Transgender” has a certain cachet, a certain alterna-cool about it for those in middle school and high school years. Declaring one’s trans status is like getting the ultimate cool tattoo or piercing body mod and provides girls with special status and treatment amongst their peers as well as school officials, employers, parents and other authorities.

This, too, has been my experience. My daughter’s social popularity rose on her transgender announcement, and what teenager wouldn’t rejoice in that–especially one who had previously had trouble maintaining friends? She attracted much encouragement and support.

I read all the statistics about suicide rates, the suffering of those with crippling dysphoria, about the bravery of coming out as trans in a hostile world — and yet my daughter displayed no such angst. She declared herself the happiest ever and demanded that we catch up with the rest of the world. Her anger and distress were only directed at us, her parents, when we questioned her transgender narrative.

One of the most heartbreaking parts of my story is the way my daughter has been encouraged to believe that we, her parents, don’t love and respect her because “we don’t want her to be happy.” Outside of our family, her friends, college teachers and the media are cheering and validating her male presentation. She is genuinely bewildered, disappointed and hurt by our inability to sign up to her self-diagnosis, without question, without due diligence. Not long ago, she reblogged a popular post on her Tumblr account. It is an illustration of a parent cutting the multicolored wings on the back of a “transgender” child.

suicide meme pink wings cropped
It’s common knowledge that teenagers always run with their peer group. They try out identities and refute parental opposition. There’s nothing new in that. That’s healthy. But it’s the untested lifelong medical treatments and surgery involved here which frighten us, and make us cautious parents – not “transphobes.” And, if my daughter does have Asperger Syndrome, does she have the ‘theory of mind’ to understand the long-term implications of what she is proposing?

Back to GenderTrender:

 The trans tweener trenders bond and encourage online via YouTube groups and web forums which function much like pro-ana, pro mia and trans-abled communities, encouraging dysphoria and censoring questioning and dissent.

The online spaces my daughter visits have become saturated with transgenderism. Many 4thWaveNow parents mention that their girls spend a great deal of time on Tumblr in particular. During Trans Awareness Week recently Tumblr was described glowingly:

 Tumblr seems like a natural fit for young transgender people to gather online, with a thriving social justice community and fandom devotees advocating LGBTQ rights, Tumblr fosters a culture of reaching out for advice from caring, experienced strangers… Tumblr’s also important because through finding one person who is similar to you, you’ll find 10 more, because they’ll be following people like themselves. When I was first working out I was trans, I didn’t follow that many other girls, but now I follow loads… the most important thing Tumblr’s trans community can give its members may be a sense of affirmation.

How intoxicating must that be? A legion of like-minded girls, with similar interests – after so many years of feeling like you don’t fit in. And how normalizing!

In my daughter’s case, I would also add into the mix the androgyny, cosplay and cross-play associated with anime and manga, and the androgyny, parental estrangement, disassociation, and angst messages that she absorbed during her previous obsession with the “emo” scene too.

Not feeling either stereotypically male or female is fine. Androgyny is fine. Trying on many identities is fine. But how did these feelings become conflated with a transgender diagnosis, when they all fit firmly into the Asperger girls’ profile too?

Here are a few quotes from parents of girls with Asperger Syndrome, which feature in the  I am Aspiengirl  book:

 “She went from princess, to tomboy, to punk, to emo to goth. She is having trouble finding out just who she is and has gotten involved with the wrong types of people. She is not interested in dating and finds flirting very confusing. She also does not seem to have a solid gender identity.”


“She has recently given up trying to fit in. She is going through very challenging teenage years, feeling even more outcast. We are now watching her embrace opposite conventions, despise femininity, social and gender rules. She is now a tomboy and a bit confused about her gender.”


“We all thought she had gone to the “dark side”. She just didn’t fit in anywhere and had no idea who she was. She seemed to despise femininity and defined social and gender rules. When she has friends, she tends to naively and blindly follow wherever they go, their rules, taking on their traits, from the way they dress to the way they talk and act.” 


“Just a few months ago, she was wearing frilly dresses and looked like a princess. Now she’s Goth and won’t let anyone call her by her new name. She has depression and panic attacks that sneak up on her from out of nowhere.”


She really struggles with sensory sensitivities, social anxiety, panic attacks and depression. She must have gone through at least three or four different lifestyle changes.


Do any of these anecdotes sound familiar to other parents in my position?

So what now? I strongly suspect that my daughter is on the autistic spectrum. I feel that she has Asperger-related issues which are impacting on her self-diagnosis of being trans. I feel transgenderism has become a special interest/ obsession that gives her relief from anxiety. All I want is to be reassured that clinicians will take care, be cautious, give her time to experience more life, to mature.

But will they?

Until I believe they will exercise proper caution, I am too scared to lead her into a therapist’s waiting room. Because I fear that, in some medical quarters, as soon as the word “transgender” is uttered, Asperger syndrome becomes downgraded to a mere co-existing condition.

In a recent small retrospective study of children presenting to a gender clinic in Boston, it was found that 23% of the patients potentially could be given an Asperger diagnosis but instead of urging caution, the researcher Daniel Shumer seemed to imply that it merely meant these kids may need to have the transition process explained more clearly.

 Given the growth of gender programs and general awareness of gender dysphoria in the U.S., Shumer said it helps to know that there’s a link between it and Asperger syndrome. He said he hopes his work will help persuade doctors to screen transgender patients for ASD and know that they may need to take more care to explain hormonal interventions to their patients on the autism spectrum.

Aron Janssen, MD, a child psychiatrist at NYU Langone Medical Center, who was not involved in the study had this to say,

It’s really about assessing what gender means to a population that may think of gender in a different way than the way most of us do,” Janssen said, explaining that thinking differently about gender shouldn’t limit treatment options for patients with ASD. In a way, people with ASD may express their gender more authentically because they’re not as swayed by social stereotypes, Janssen said.

Aron Janssen has recently taken part in an interview with The Ackerman Institute for the Family, which he has posted to the WPATH Facebook page. In it, he gives his view that gender dysphoria is a completely separate entity from autism spectrum disorder. He states that recent research has found an overlap between individuals who have gender dysphoria and individuals who have an autism spectrum disorder but we don’t really know why that is.

One of the implications for treatment, he says, can be that patients with autism who may have a “theory of mind” impairment could have difficulty in understanding how to communicate their internal gender identity to the outside world; in other words, they may not understand that how you speak, dress, act and appear are important to how people view your gender presentation. They may need help with that.

A Reddit commentator with Asperger’s would agree with that impairment, but reaches a different conclusion on the help needed:

 I can’t speak for all people with autism (I have Asperger’s), but I think a lot of people with autism spectrum disorder are confused by the messages that society puts out about how to act and how to perform gender. I always felt like I didn’t fit in with women when I was growing up. Had I been born later, I have to wonder if I’d be picking up this trans narrative and taking it to heart. This is not the kind of help that young people with autism need. They need appropriate services, help finding their way into jobs and meaningful social connections, not hormones.

Dr Janssen, however, appears to take a different perspective.

 For too long individuals with autism who have had gender dysphoria have had that gender dysphoria dismissed as filling category 2 of autism- that restricted or repetitive interests or behaviors – and their gender identity was thought of as a symptom of autism, as opposed to something that is genuine for each individual.

As such, he believes he needs to help patients express their own autonomy and give them access to the care they say they need.

Which all sounds great, if we weren’t talking about letting children with cognitive vulnerabilities make decisions about irreversible treatments before their brains reach full maturation!

My last point is this:  So much of the research available cites case studies of patients who have experienced gender dysphoria from a very young age. Information about the clinical management of SUDDEN, LATE ONSET gender dysphoria in YOUNG TEENAGE GIRLS has been impossible for me to find on the internet. 4thwave’s blog is the only place I have found where this particular path to transgender presentation is being discussed.

More importantly, parents are also beginning to come here to tell about desistance in their daughters. These stories are important. (These stories give me hope.) If you have a similar one to tell, please share it here. My plea to clinicians is that they read these accounts and adopt a WATCHFUL WAITING approach for this group of teens and young adults.

 

A “gay boy in a girl’s body” desists: Guest post

This is a guest post by long-time 4thWaveNow community member overwhelmed. She is available to respond to your comments and questions in the comments section for this post.

Most trans activists and gender specialists will concede that at least some prepubescent children will grow out of gender dysphoria. (How many? No one knows, but it’s a current hot topic which I’ll be tackling in a post in the near future). But it’s touted as if it were gospel that once puberty hits, if a teen says they’re trans, then they are–case closed. Gender dysphoria at puberty = gender dysphoria for life.

As my own personal story attests, this is simply not always the case. I’ve been hearing from more and more young people who have bucked this supposed hard-and-fast truism. And now we hear from another mom whose daughter has changed her mind.

It has long been known that upwards of 90% of gender dysphoric girls are same-sex attracted, but overwhelmed‘s daughter is one of a growing number of young women who are opposite-sex attracted but who also believe themselves to be transgender.

As I experienced with my own teen, overwhelmed tells us that most of the medical and psychological professionals she encountered–far from being cautious and methodical about handing out a trans diagnosis–rushed to the assumption that her daughter was transgender simply because she claimed to be.

Seeing a pattern, readers?


Another mom listens to her gut

 

by overwhelmed

Earlier this year my daughter revealed that she really was a gay boy trapped in a girl’s body. She had never shown any previous signs of discomfort with her body so I was confused by this belief, especially the urgent desire to medically transition NOW!

I called my pediatrician’s office for a referral to a psychologist for my daughter. The nurse who answered the phone had just attended a transgender educational seminar and felt like she knew all about my daughter, even though she had never met her. This nurse completely dismissed my over 16 years of knowledge of my daughter. Just like that. She told me that my daughter’s pre-existing depression and anxiety were symptoms of her being transgender, not the other way around. I told her that my daughter had been online in Tumblr communities and had watched a lot of YouTube transition videos that had likely influenced her. The newly educated nurse, however, basically told me that I needed to accept that she was transgender, and to start supporting my daughter in being her authentic self.

My daughter’s first psychologist also completely dismissed any knowledge I had about my daughter. At the time I was just relieved to have found someone to talk to my daughter who I was concerned might be suicidal. I was happy that this psychologist had experience working with others who were transgender. I mistakenly believed that she would be able to tell that my daughter wasn’t an authentic trans boy. While traveling to and from her therapy sessions, I shared transgender scientific research with my daughter— that many people identifying as transgender have mental health problems, that the vast majority (80%) of kids outgrow their gender dysphoria, and so forth. I didn’t realize it initially, but my daughter was also sharing this information with the psychologist. And, the psychologist was telling my daughter that the information I was telling her was bogus, made-up information. She mentioned that she had a PhD and knew much more than I. She told her that I shouldn’t believe everything I read online. She told my daughter that she wanted to include parents during the next session so that she could “set me straight” on the facts.

I fired her.

In the meantime, I felt the need to get information out there, so that other parents could benefit from the information I had found. There is such an overwhelming amount of information online touting that gender is unchanging, that transition is the only cure. I know this is wrong. All you have to do is look at the scientific research, or even to the growing number of detransitioners who are speaking out. I started submitting comments to transgender media articles and even on some parenting forums. I am a person who tends to be pretty careful in what I write, never intending to be offensive, but one site I went to banned me immediately because I recommended googling “transgender regret” as a way to get information from a different perspective! I have also had quite a few comments on media articles disappear due to similar recommendations.

Overall, as a parent who did not buy into my daughter needing cross-sex hormones and lopped off breasts, I am ignored when I voice my concerns. I’m silenced. I’m vilified. I’ve been called transphobic and gleefully told that it isinevitable that my daughter will commit suicide due to the lack of support.

Unfortunately, parents concerned about their trans-identifying children face a perfect storm of opposition. They are battered from many directions, told that they are wrong, warned that if they don’t start supporting their child that suicide is a likely outcome. These messages come from their own children, the overwhelming pro-trans voices online, the news and media, medical professionals, government officials, and even school districts.

I admit that there were times when I doubted my gut instincts. But, fortunately I was able to find a group of parents in the same situation (thanks 4thwavenow!) and have greatly benefited from their support. And, fortunately I found another therapist for my daughter who was able to uncover the reasons she felt disconnected to her sex. She had once felt powerless as a female (due to some traumatic experiences) and thought a male identity would be a better fit. Now she no longer identifies as transgender. While still eschewing most things considered conventionally feminine, she has embraced the fact that her presentation and passions don’t make her any less female.

Although I am able to relax about my own daughter’s status, I am still very concerned about the vast majority of parents in this situation. I fear that many won’t find the support system that was so beneficial to me. I fear that they won’t be able to find a mental health professional that will try to uncover their child’s underlying reasons for identifying as trans. I fear that many parents will succumb to the pressure.

It shouldn’t be like this. There shouldn’t be so much pressure against parents who are genuinely concerned about their children’s health.

Internalized homophobia & teen dysphoria: More reader comments

This week, I’ve been featuring comments submitted to this blog. Today, there are two selections: a commenter asking what the solution is (if not transition) for a female who is sexually attracted to other females, but cannot tolerate the idea of being a woman herself; and a 15-year-old who identifies as trans male. This teen feels angered by what I and others write here, believing we don’t understand.

First, from Dagis:

What if the sexual preference for a natal female is for a female, but only if the natal female were male? That is, what if the natal female does not self-identify as lesbian, could not conceive of being a female having an intimate sexual relationship with a female, but desires an intimate sexual relationship with a female as a male? I’ve yet to see this addressed by critics of “transition,” and yet I have seen this expressed by those considering FtM transition. Perhaps this is generally dismissed as “oh this person is just a ‘closet lesbian/gay,’ and therefore it’s not actually examined. But if it is a real issue for someone who identifies in anyway as having difficulty with their birth assigned sex, and such a person does indeed express desire for intimate sexual relationship (not homosexual), then what is a compassionate and logically sound response to such a person?

“I am attracted to women but I’m actually not a lesbian, I’m a straight man.” This assertion is a key part of nearly every transition account I’ve seen–including from women like Aydian Dowling, who lived happily as a lesbian before deciding she was a man.  (I always wonder why the prior lesbian life is presented as somehow less real than the subsequent life as a heterosexual man).

Trans-identified natal females stringently deny that their desire to convert to heterosexual males is in the least motivated by internalized homophobia.  But why else, then, would a woman be unable to “conceive of being a female having an intimate sexual relationship with a female”?

The accounts of female-to-male transitioners often revolve around a feeling of disgust for one’s own female body.  Transition vloggers are careful not to use anatomically accurate words that might “trigger” their viewers; euphemisms like “down there” and “junk” are substituted for the rejected body parts.  But clearly, for these women who desire to be heterosexual men, it’s not a generalized revulsion for female bodies;  they want to be intimate with other women.  Yet dis-identifying with and speaking disparagingly about one’s own female body, and taking comfort in the thought that they can be transformed, via hormones and surgery, into straight men–how is that not, at base,  a form of internalized homophobia?

As I’ve said many times, I have no difficulty acknowledging that some trans-identified people do feel intense dysphoria or dissociation from their bodies. That is an experience, and as such, it is subjectively real.  What right would I have to deny the feelings and thoughts of another person?

So as Dagis asks, what’s the compassionate and “logically sound” response (apart from simply agreeing that transition is the answer) to same-sex attracted women who are adamant that they cannot stand the thought of being sexually involved with someone of their own sex? I hate to say it, but I suspect most of them are just going to cover their ears if all they hear is feminist analysis.


Next, there is this comment from Kenneth, a 15-year-old who identifies as trans male.

This blog absolutely has pissed me off. To the people who have been saying that this whole Transgender thing is wrong and that people who identify as trans are only going through a phase, you have no idea about it. There are are thirty year olds who have identified as trans since they were old enough to understand that the gender of the their body did not match the one inside their head. I have identified myself as male before I barely knew what Internet was, I’d like to see you calling me ‘brainwashed’ by the internet. But at the age of twelve I was mildly obsessed over YouTube, I enjoyed watching YouTubers such as Smosh and Annoying Orange and etc. but I soon found a YouTuber that goes by the name of Alex Bertie, who has been identifying as male since he was fourteen; as of now he is 21 and personally goes and makes his appointments for his gender needs and hasn’t once had any doubts his doings.

I’m currently fifteen, I do identify as male regardless of what my body is. Could I possibly change my mind in a couple years or even months? Possibly, I’m not going to say it’s impossible but you sure as hell aren’t going to find me doing it right now; wearing girls clothes or mildly looking like a girl? No, that sounds like absolute hell and feel sorry for the children who have to go through that now. Normally children go back to their birth gender because society says that what they’re doing is wrong, some children even commit suicide because of this horrible issue. It isn’t wrong. I’d like to see your reaction if you were somehow ‘magically’ put into a male/female body but were born male/female. Would you like that? Would you try your hardest to become the gender you know yourself as?

Children also do not wish to tell their parent they are trans because the fact they feel like they’re going to be rejected. Many children of the LGBT+ community are thrown into the streets or are still allowed at home but are abused because of this ‘issue’.

I don’t doubt that Kenneth decided s/he was stereotypically male as a child, before being exposed to the Internet–although Kenneth’s subsequent experiences watching other trans-identified  people (like Alex, one of the many “YouTube famous” transitioners) had an impact in cementing that identity, no doubt.

But notice what Kenneth defines as being female: to “wear girls’ clothes or mildly look like a girl.” Because what is it to be a 15-year-old girl, apart  from clothes and looks and–what? Which video games you prefer? What does “girl” even mean to a teen like Kenneth?

I have never once heard an adult trans-identified person actually answer the question: What is a man? What is a woman?  apart from saying “it’s whatever I feel I am.” And I sure don’t expect a teen trans-identified person to be able to respond with any more clarity. But Kenneth: Are your feelings of being the opposite sex rooted in your preferences for the activities and appearances of the boys you’ve been around? What exactly is wrong with being a “gender nonconforming” girl?

Maybe this is what’s wrong: Kenneth brings up being rejected by parents. There is no doubt that “gender nonconforming” kids are more at risk for self harm, and that some do actually kill themselves due to, as Kenneth rightly calls it, this “horrible issue.” One of the risk factors for poor self esteem in LGBT teens is lack of family support, but how much of that is down to the pressure to conform to rigid gender stereotypes and norms?

Kenneth, parents like me aren’t rejecting our kids. We want to support them in expanding what it means to be a girl (or boy).  In fact, we actually see medical transition as another, potentially very serious form of self harm–even self hate.  And transition does not appear to be a magic long-term solution for many young people; witness the rash of teen suicides in 2015, several of whom were fully supported in their transition by family, teachers, and friends.

Kenneth presents this challenge:

I’d like to see your reaction if you were somehow ‘magically’ put into a male/female body but were born male/female. Would you like that? Would you try your hardest to become the gender you know yourself as?

What Kenneth is saying is: I hate this body. I want out of it. If you hated your body as much as I hate mine, wouldn’t you do everything in your power to escape its prison?

Kenneth, I don’t know what it’s like to feel extreme dysphoria; to want to drastically alter my body, even if it means a lifetime of surgeries and doctor’s appointments. I have fantasized, on more than one occasion, about being a man–down to every anatomical detail. I can even say that I’ve mightily wished I were a man at certain times in my life. But it has not caused me the misery you are talking about here.  There are quite a few women who have been there, though, like this one. And there are several more in my blogroll (linked on the right side of the page) who have been down the same path you’re on–but returned home to realizing themselves as female.

I don’t doubt your pain, and your determination to do something to relieve that pain. Nor do I doubt that you sincerely believe your mind knows better than your body;  that you think your body is alien and wrong.

But I don’t believe the intense desire to be something you are not means you are actually male.

I wish there were more therapists and caring adults who could support  teens in exploring options apart from “transgender.” Breaking out of gender stereotypes is a good thing, a brave thing for a teen to do.  But where are the non-trans-identified role models for these young people? Where are the YouTube stars who have chosen not to transition? Wouldn’t it be great to see a series of vlogs that aren’t “one year on “T,” but “one year in my journey to reclaim myself as a strong and independent girl?”