Toward a more nuanced exploration: An interview with Sasha Ayad

Sasha Ayad, M. Ed., LPC, is a Licensed Professional Counselor who works in private practice with teens and young adults who are questioning their gender. We interviewed Sasha via email for this post.

She uses an exploration-based approach to seek out underlying issues and help her teen clients move towards self-awareness, resilience, and long-term well being. She also conducts occasional consultations for parents whose teens present with gender issues first emergent around puberty.

In a monthly newsletter, Sasha’s reflects on interesting psychological material, and relates it back to the phenomenon of a sudden presentation of gender dysphoria in adolescence. She also offers advice for parents as they guide and support their gender-questioning teen. Readers can sign up here to receive the newsletter and Sasha’s PDF on how to search for effective therapists and individualized treatment.

Sasha has a full caseload and long waiting list, so is unable to take on new clients. However, Sasha offers a subscription-based Patreon account with videos designed to help parents engage in trusting and productive dialogue with their gender-questioning teen.


Tell us about your background, training, and work as a therapist.

In undergraduate school, I studied psychology and history. My graduate program was focused in counseling psychology, or the clinical practice of therapy. I’ve worked in the field of behavioral therapy and mental health in Houston, Texas since 2005, and in a counseling capacity since 2008. I spent many years working with young children on the autism spectrum through applied behavioral therapy. In the field of domestic and sexual violence, I worked as an individual and group therapist with women and children. I also developed and ran the first counseling program at a state-supported residential facility for adults with intellectual disabilities and concurrent mental illness. In recent years, I worked as a school counselor for underserved populations at a top-ranking charter school.

I am now working in my private practice full-time, based here in Houston. Most of my work is conducted online, and I see teen and young adult clients from all over the country and internationally. I specialize in working with adolescents who are questioning their gender and most of my clients are female. I also conduct occasional consults for families who have children presenting with Rapid Onset Gender Dysphoria, and create content for my monthly newsletter and video series.

I am a Licensed Professional Counselor (LPC) in Texas, and I hold a master’s degree in Education.

What specifically sparked your interest in working with adolescents and adults who have gender identity issues?

My interest in this population developed and grew organically out of my own desire to better understand the growing phenomenon. When I was a young graduate student, my understanding of this issue was limited and I was marginally familiar with the conventional, textbook examples of childhood gender dysphoria: a person, who from a very young age, is completely convinced their body is the “wrong sex.” In these cases, the wrong body self-concept develops, seemingly independent of societal norms and environmental influences. I used to think, “what a strange and troubling experience: to really believe you have the wrong sexed body.”

Even back then, I did hold skepticism about this narrative, with its heavy reliance on gender-atypical preferences and behaviors supplying the “evidence” that the child is actually in the “wrong body,” and therefore needs to socially and medically transition, however outcome data shows some patients may benefit from a medical gender reassignment. Around 2012 I began more deeply investigating this idea of gender identity out of personal interest and professional curiosity. Keep in mind, this was before the huge boom of trans-identified kids in the years to come. I started to wonder how things like socialization, gender norms, or even sexual trauma may play a role in the idea of the “wrong body.” I also became curious about the underlying suppositions of “gender identity”: that one’s “correct” biological sex or “authentic self” is always correlated with feelings of congruence between mind, spirit, and body (i.e. innate gender identity). Couldn’t “cis” also people feel varying degrees of gender/sex incongruity at times?

As time went on, I eventually discovered the work and writings of detransitioned people. I read about how quickly they were “affirmed” and shuttled towards a path of medical intervention, circumventing thorough evaluation or less invasive means of symptom-reduction, which are foundations of ethical therapeutic practice. I became very disturbed by what seemed to be a failure of mental health practitioners, who were responsible for their care, to look at these young people as whole and complex individuals. Were many in our field simply blind to the myriad factors, both social and subconscious, that might contribute to the feeling of being “trapped in the wrong sexed body?” I grew quite baffled that therapists were treating gender identity without any of the thoughtfulness, intuition, or even clinical curiosity typically afforded to other presenting problems – not to mention the care historically mandated by our psychological ethical standards. And looking at the sheer number of young girls suddenly adopting a trans identity around puberty, I became curious about this emergent population of gender dysphoric girls (and some boys).

I eventually stumbled upon this brilliant podcast interview with Lisa Marchiano, and my jaw dropped to hear another professional bravely speaking her mind and echoing some of the same fears I held. I reached out to her immediately and soon got connected with your work at 4thWaveNow, Transgender Trend, and many other resources for parents.

Sasha photo

Then in 2015, as a school counselor, I was required to take part in a training on “Supporting Trans and Gender-Diverse Youth.” To my disappointment (but not my surprise) the presenter (who was not a psychologist, but an advocate) completely failed to put forth a nuanced, thoughtful analysis, and even skirted issues when I brought them up during the training. I arranged several meetings with my manager at the time, the head of the counseling program – my goal was to present her with evidence of wider phenomenon and some of the less obvious problems with the unidimensional, non-scientific training we were receiving. She graciously and thoughtfully listened to my concerns but admitted that there was so much she didn’t understand about the changes in the LGBTQAI movement, and she felt it was important to continue developing our counseling program according to the gender identity activists. I believe proponents of this affirmation narrative deliberately use “newspeak” and made-up language to confuse professionals into a state of self-doubt and subsequent willingness to dismiss their own intuition and clinical knowledge. And that’s exactly what might have happened to my manager, who is an incredibly brilliant, experienced, and competent social worker.

At that point I decided I would no longer take part in organizations that are committed to an activist cause rather than individualized, holistic, clinical perspectives on gender dysphoria. Schools are promoting this one-sided view unquestioningly to their mental health staff and to the children they claim to serve. I also realized there is a scarcity of therapists working with these children in a manner that adheres to comprehensive clinical standards. On the other end of the spectrum, some religious therapists seemed to avoid or discourage any type of gender and sexuality exploration, which is also not helpful to the client. So, I decided to build the kind of therapy practice I thought was lacking for trans-identified youth. I started my practice part-time in 2016 and have been working independently in private practice full-time since July 2017.

Do you have a personal interest in this issue? Do you have relatives or friends who are affected by the current wave of transgender identifying children and adolescents?

Not until recently. A few years ago, when I worked as a middle school counselor, there was one child who was especially memorable; I spent much time with her, both as my counseling client and while chaperoning extracurricular activities during my three years at the school.

She stood out from other students in multiple ways. Despite having many brilliant and creative peers, she excelled in so many disparate domains, being a fantastic sketch artist, dancer, writer, and academic learner. She had impeccable grades in every subject and treated her peers with kindness and fairness. She created incredible logos and t-shirt designs for clubs and school events, and played leadership roles in many campus groups: anime, drama, orchestra, art, and more. I have several beautiful pieces of art that she’s created for me over the years, mostly portraits of female characters, reminiscent of Japanese-style manga. Her appearance was also creatively inspired: she experimented with various hair-cuts, styles, and colors, and expressed her own personal fashion sense (and progressive political leanings) through graphic jewelry and buttons on her messenger bag. I always praised her for carving out her own sense of style and individuality.

She identified as bisexual at the time, and she was a great student-leader in my GSA club, showing initiative and often taking responsibility for large portions of our meetings. I was always careful in how we navigated conversations about gender and gender identity and she seemed to be well-grounded in her own unique expression of female identity. She was never particularly feminine, especially as a seventh grader, when there is immense social pressure to look a certain way. She always had lot of friends, was overall quite happy, and she was just one of those kids I never thought I’d have to worry about. I imagined her starting a graphic design company one day, or maybe being a video game software engineer. Really, her options are limitless.

I found out recently that she has come out as trans, and that she wants to transfer to a different school so she can start her new life as a “trans boy.” In my hours and hours of being with her, she never expressed thoughts of gender dysphoria, though I do remember that once she drew a picture of a pensive “non-binary” character and “their” girlfriend.

It feels like our best and brightest, our most creative and unique girls, are suddenly taking a detour as they devote a huge amount of energy and time to questioning their gender. The kids I meet in private practice are first introduced to me in the midst of their gender concerns, but it’s quite profound to have known someone before the identity-change, when they were happy and full of life. To think that she’s now disconnecting from her female-self can feel quite perplexing. It seems that her parents have fully accepted the wrong-body explanation and claim to have “always known she was a boy.”

How would you describe your therapeutic approach?

I’m pretty explicit with my teen clients regarding what to expect in therapy, because I believe truth, honesty and trust are foundational aspects of any successful relationship, counseling included. I tell them something like this: “I’m different from ‘gender therapists’ you might have read about online because I won’t just meet with you one or two times then write you a letter for endocrinology. I believe my job is to help you explore who you are on a much deeper level. First I’ll spend a lot of time just asking questions and listening so I can try to understand what’s going on in your mind, heart, and body. Then we will work together to figure out what your particular experience of gender dysphoria looks like, where it might have come from, and what we can try to reduce your distress. In sessions, I’ll encourage both of us to ‘be curious’ about your experience because the more you can learn about yourself in counseling, the better you’ll be at thinking for yourself and making good decisions about your identity, your body, and your life. Sometimes counseling can be hard but we will work together to gently face the scary or painful stuff and see if you can learn more about yourself and grow bigger in the process. We can also look for ways to loosen the grip that pain or dysphoria has over your life so that you can have more options and be more confident.”

As for the specifics, my approach is highly tailored to the constitution, mindset, resilience, age, history, development, and maturity of each client. I always start with trust and initial bonding, which can be hard with some clients who have been taught that therapists should act as nothing more than GD diagnosis signators for top surgery or hormones. With more open clients, who are less defensive and more conversationally or intellectually predisposed, we might discuss their personal philosophy of gender identity and I give them space to sort through any doubts they might bring to the table. With other clients, who are in a more sensitive or fragile place, I may approach their identity indirectly, focusing instead on the underlying pain that is somehow finding relief in this new self-concept. I also like to pragmatically examine how taking on a trans identity will play out regarding a client’s self-confidence, their ability to exist in the world, how they relate to family, friends, and so on. Sometimes I have to start somewhere very basic, like assessing if the teen even understands what the words “male” and “female” mean, if they know anything about sexuality (age-appropriate understanding), or what they know about their own bodies.

The ideas that influenced my perspective at this point are quite eclectic and not restricted to the field of psychology, though I’m deeply grounded in a back-to-basics, individualized, and holistic approach. I draw from Acceptance and Commitment Therapy, Cognitive Behavioral Therapy, behaviorism, social psychology, anthropology, history, and Taoism. More recently, I’m returning to a deeper exploration of psychoanalysis and Jungian analysis, which I find to be tremendously useful in making both micro- and macro- interpretations of what’s happening with my clients.

I also work closely with parents while respecting the confidentiality of the teen client. Having calls with my caseload parents every six weeks or so has proven to be incredibly important to the therapeutic progress of the teen client. Teen accounts of family dynamics often gives me insights into how parents can deepen their relationship with their teen or engage in more effective communication with them.

I’ve had very good feedback from my teen clients regarding their feelings of safety in session and ability to express themselves. I often hear that teens feel a great amount of pressure from others to “pick a label” and that our sessions are nice because they can explore gender without it needing to be so concrete. At times, a young person’s gender identity may be playing an important role in their ability to exert autonomy or feel successful in social relationships. In cases like these, we might explore the new-found confidence a client has gained and locate it’s source within the client, rather than affixing it to the identity persona. This is just one example of how it’s possible to work with gender identity in a nuanced way that isn’t necessarily challenging or a literal affirmation.

Are you able to work across state lines, or must your clients be in the state of Texas?

Unlike clinical psychologists, LPCs can see clients in other states and outside the country, though I practice based on the regulations in the state of Texas. I make this clear in my initial consent conversations and documentation with new clients.

How has your your practice been going so far? Have you received any hateful or angry pushback? If so, how have you handled that?

Unfortunately there have been two separate attempts to formally attack my license, both of which I have responded to strongly, since they are gross mischaracterizations of my work. When people submit formal complaints to a licensing board about a practicing clinician, it’s most often a client or former client who feels maligned and harmed by a direct personal interaction. In the attacks made against me, however, it was other activist-clinicians who lodged the complaints. One attack is from an activist with whom I’ve never even spoken, from the other side of the country. The other complaint was really shocking since it was submitted by a former colleague of mine with who I felt a strong sense of mutual respect and camaraderie during our time working together. The lack of professionalism and integrity she displayed with this covert act of aggression has been very sobering. When colleagues don’t even attempt to reach out to one another and discuss their concerns, and instead go after someone’s livelihood, the profession itself feels degraded. In addition to these types of serious attacks, of course, common trolling and insulting comments on my social media accounts or blog posts happen occasionally. However, when I speak with people about my practice face-to-face, I am typically met with far more inquiry and curiosity than vitriolic responses. Exceedingly the response I’ve gotten about my work from clinicians and parents has been positive. Therapists indicate that they find my work insightful and that it has helped them better treat their own gender-questioning teen clients. My approach is very much grounded in foundational ethics of clinical practice, so the fact that it’s sometimes called “controversial” should raise a red flag about the novel and unscientific recommendations being pushed by gender identity organizations (and now by the APA).

Do you believe there is such a thing as a “truly transgender” child or adolescent? Why or why not?

It’s hard to answer a question when the terms of each word haven’t even been defined well. There’s no definition for “transgender” that isn’t completely circular in logic. Perhaps a better question is, “are there some children for whom the benefit of social and medical transition outweighs the risks”? Or maybe, “are there some children who, in order to live vital meaningful lives, must live in the gender role of the opposite sex”? To cover all my bases, let me include a question the gender therapist might ask too: “if a child is threatening to kill themselves, isn’t it better to support their transition?”

My answers for adults would look very different, because I do believe that for some, a transgender identity and transition are a means of true individuation and authenticity. For children, however, let me tailor these questions a bit.

1. “Are there some children for whom the benefits of social and medical transition outweigh the risks”?

If by “risk” we mean feelings of body discomfort or incongruence, then trying to prevent that risk seems impossible. Discomfort and biological limitations are ubiquitous and necessary aspects of human experience, and it’s always been true that body discomfort is particularly acute in adolescence. The struggle associated with changing social roles around femininity and masculinity, hormonal and physical changes of the body, independence and safety, social cohesion and isolation, assertiveness and passivity, and every other fundamental human developmental endeavor requires us to grapple with our own pain and limitations. Without that struggle we don’t develop resilience, we don’t learn about ourselves, and we don’t learn anything about living in the real world as it is, materially or socially. With the growing evidence that social contagion plays a role in puberty-onset gender questioning, we should be exceptionally cautious before medicalizing any kind of identity exploration.

That being said, it may be that classic cases of absolute insistence on being the opposite sex from the age a child could walk and talk are a different story. Of the hundreds of families I’ve talked to, only a few of them have kids whose gender dysphoria started in early childhood. Perhaps those families are more comfortable with medically transitioning their children, so they don’t contact me as much. Since I’ve not really worked with those kids, I don’t feel I’m qualified to prescribe their best treatment.

2. “Are there some children who, in order to live vital meaningful lives, must live in the gender role of the opposite sex?”

A “good life” doesn’t come from never experiencing discomfort, or conversely from always being perfectly comfortable, which I addressed in the previous question. But perhaps someone assumes that a girl who prefers or expresses strong masculinity would do better living “as a boy”? Are certain traits or behaviors literally incompatible with being a female in society, or a man in society? Well, what does this say about our capacity to broaden independence and make room for personal preferences? And if someone does take on non-conformist roles, should they not also develop the personal resilience and emotional fortitude to stand firm in their own presentation with strength and individuality? I think there’s something inherently flawed about expecting all of society to completely abandon every aspect of our historically stable gender roles and it’s also flawed to say there’s no room for individuals to choose how to express themselves on the spectrum of femininity and masculinity. I would like to emphasize again that adults should be free to explore a medical gender transition as an option, but may also find it meaningful to consider these interesting questions for themselves.

3. “If a child is threatening to kill themselves, isn’t it better to support their transition?”

If a child is threatening to kill themselves, we should take a huge pause and think of the big picture. The most empathetic thing we can do initially is to listen with care, but we, as adults, also need to determine if this child is thinking clearly. Since when do emotionally unstable, demanding children get to use threats to dictate decisions as important as fertility and surgery? Furthermore, if a child is that disturbed or troubled, then they are clearly in no position to make good choices about their long-term well being. The use of this threat by some advocates is incredibly manipulative and has no precedent whatsoever in the field of psychology. Over the last ten years, I’ve worked with dozens of young people who are actively struggling with self-harm and making suicidal statements (whether related to gender identity or not). These behaviors can serve many functions, not the least of which are expressing psychic pain, gaining attention and care from adults, or trying to manipulate people in power into making a concession of some sort. Children who haven’t developed the emotional or relational tools for self-soothing will use any means necessary to express pain and gain what they are seeking. I don’t mean to deride a child’s methods; she’s doing the best with what she has at the time. But these are reflections we must take very seriously as clinicians. So giving into these types of threats does far more harm than good for the child. We need to instead, conduct thorough risk assessments, create conscientious collaborative safety plans with the child and family, and work through underlying issues if we really care about the child’s safety and well-being (as therapists have always done with suicidal ideation).

In the current atmosphere, professionals who question the current “affirmative” approach to therapy for trans-identified kids may be risking their careers. Do you think the concern is overblown?

This is a touchy area so I want to start by saying that I can understand the pressures therapists feel from their institutions to make politically favorable choices and statements. Many clinicians also have their own family to be responsible for and feel financial pressures to not “rock the boat.” In recent times, some professionals have been demoted or sanctioned for sharing their clinical impressions, which indicates a horrific direction our field is headed down. However, we have all taken vows of high ethical standards and we are responsible for making sure the work we do reflects our professional integrity.

Personally, as I’ve considered this question, I find myself asking: what’s the point of having a career based on helping others if you have to lie every day about harm that’s being done? And what does the collective and cumulative impact of lying and silence about this issue amount to in the long run?

Honestly, I don’t know what is going to happen in the next five, ten, or twenty years. In recent times whenever skeptical, intelligent, and nuanced articles about transgender children appear, there’s often a dangerously aggressive and thoughtless effort to dismiss and diminish important arguments. The way things are going, I would not be surprised if things “get worse before they get better.” That being said, I am not worried about the work I’m doing because I believe it to be the right thing to do. Standing up for ethics is easy until it’s not. I am deeply committed to standing up for individualized treatment, nuanced assessment, and a least-invasive-first approach, even if that means it puts me at some personal/professional risk.

I strongly encourage other clinicians to speak the truth and be honest about what they are seeing in their clinical practice. Complicit silence only makes more room for oversimplified caricatures of our patients, and in the end, the gender-questioning teens will be the ones who suffer from our lack of nuance as professionals.

What will it take for more therapists to come out publicly in offering alternatives to the transgender-affirming approach to therapy?

Clinicians should be thinking more broadly about adolescent psychology, questioning suspicious claims carefully, educating themselves on multiple perspectives, and finally, acting with honesty and courage. Because when I talk with most therapists one-on-one, there’s a deep intrinsic knowing that the field has spiraled out of control with regards to childhood transition, but people are afraid to even think deeply about it, question claims, seek out knowledge, or speak up.

The APA has issued “guidelines” for the treatment of what they term TGNC clients (transgender gender nonconforming). Though not binding, these guidelines are nevertheless considered “best practice.” Do you agree with them? If not, how does an APA member go about recommending changes to them?

I am not an APA member, since I am an LPC (Licensed Professional Counselor), and not a clinical psychologist. However, the APA is a powerful organization and their guidelines are looked to as aspirational principles which have significant impact on how therapy is informed and practiced. I disagree with the guidelines and believe they violate some of the most basic ethical standards, including beneficence, avoidance of maleficence, fidelity and responsibility. I believe the infiltration of political ideology into non-political organizations is the main confounding element in the organization’s ability to adhere to these professional values.

Regarding TGNC, some trans activists have essentially co-opted gender nonconformity under the “trans umbrella.” Who does that leave? No one is 100% “conforming” when it comes typical gender expression. As you know, we at 4thWaveNow support such gender atypicality in our kids, but we strongly resist the notion that this means they are somehow “transgender.”

I agree – even trying to amalgamate “gender non-conforming” people into some semblance of a group is an impossible task since, like you said, no one is 100% “conforming.” We all exhibit traits of masculinity and femininity, and it’s absurd to try and find some line that constitutes “cis” and “trans” – according to some of the definitions of those terms floating around. I believe concept creep is also playing an important role in how the definition of gender dysphoria has been broadened so dramatically in scope.

What are your views on the possible influences of parenting dynamics on children identifying as transgender?

It’s becoming harder and harder for parents to keep their children safe from questionable beliefs about gender, since they have infiltrated our medical and educational institutions. But I do recommend some possible means by which parents can safeguard their kids:

  1. Due diligence in being aware of the types of ideas being taught at your child’s school: from early elementary all the way up to university. I know that’s a daunting task!
  2. Do what you can to monitor your child’s internet use and actively talk with them about some of the ideas they come across. Engage your child and really listen: let them share their thoughts, use that time to gather information and establish safety around certain touchy topics. Then engage them in thoughtful, critical, and deep analysis (in an age-appropriate and thoughtful manner). As a side note, I never imagined myself to be someone recommending an invasion of your child’s privacy; I’ve always been quite open-minded. But spending too much time online has proven to have very dangerous potential, so the long-respected parental role of boundary-setting and limit creation is crucial here. For young teens, temporarily monitor their internet use to get a sense of what material they are viewing frequently. This will help you gauge what you need to attend to or talk about. In general, the more you can keep them offline, engaged in fun, social, real-life 3D activities, the better. Go outside together, leave your phones at home, go for hikes, take them fishing, and just generally reestablish a connection to the natural world.
  3. Help them regulate their eating and sleeping cycles, which play a crucial role in mood and depression. Sometimes kids stay awake, staring at a screen all night, filling their mind with anxiety-producing content. Set their bed-times, take their phones away overnight, and make sure they eat regularly and get plenty of physical exercise, real-life play, and social interaction (I know it’s easier said than done).
  4. Have a clear sense of your own family’s values and moral direction. What do you believe in? What ultimately guides your decisions, behaviors, beliefs, etc? How do you create meaning in life? Give them a strong foundation based on your own belief system. Model what you want them to learn. Don’t be dogmatic, but help them make connections to what is true and supports their long term well-being. Even if they explore other ideas in their teenage years (which is part of their own individual morality-development), having a loving stable foundation gives them something to come back to or build upon.
  5. Don’t obsess over gender, but also don’t try to pretend it’s completely irrelevant. Set boundaries around any kind of physical manipulation or medical intervention. Binding breasts is a physical manipulation which can be harmful in the long run. Hormones and surgery should be off the table for children. But don’t get hung up on haircuts or clothing.
  6. Don’t argue with your child about whether or not they are “actually trans.” Don’t bother thinking back about their childhood, wracking your brain for “signs” of being different or non-conforming. A more pragmatic framing is to think about the real discomfort they are having, and ways to deal with it that don’t require completely transforming into a new person. That being said, take the time to really listen to the gripes they have with their sex roles, social problems, or body discomfort. They likely have some very poignant observations and ideas to share if you can get past scripts and jargon.
  7. Don’t be afraid of emotions (your own or your child’s) in conversations with your teen. I’m not sure if this is a cultural thing, but I’m sometimes surprised by how afraid parents are that they might upset their child. I come from a family and culture in which open expression of emotions is very common and I have found it can be very healing when done carefully. Being honest about what you think is incredibly important, and deep emotional talks with your child are going to get turbulent – and that’s ok. It’s necessary to tell your children the truth, disagree, and show your own vulnerability. Go ahead and lovingly explain how you see things, while knowing that their feelings are real and important too. They need to hear the truth from someone who really loves them, because they aren’t going to get the full picture from friends or the internet.

An RN & mum of a trans-identified young adult on perils of off-label cross-hormones as first-line treatment for gender dysphoria

Mumtears is a registered nurse, a wife, and mum of two daughters, currently aged 23 and 20 years old. She lives with her husband of 27 years, the father of her two daughters. She says: “Because of my currently unpopular thoughts, and because of not wanting to cause harm to my family, I feel I need to remain anonymous. I also started a blog a while ago, but- frankly- I haven’t kept it up. I am not very technologically sophisticated. If you want to read what there is in my blog, you can find it at myheartandhope.wordpress.com.” She can be found on Twitter @Mumtears1 and is available to interact in the comments section of this post.


by Mumtears

I have been a registered nurse for 30 years. From childhood, I always wanted to be a nurse. I really feel like being in the nursing profession was a “calling” for me.

While going through my post-secondary studies, studying for my Bachelor of Nursing degree, I recall being taught that, in all conditions, medical and nursing treatments should always begin with the least invasive way to treat that condition. I was taught that this was best practice care for the human body.

I have had many years’ experience working in Acute Care Pediatrics at our local children’s hospital. It was there that I learned that children are not simply “little adults”. Pediatric patients require specific attention and care, due to their rapidly developing minds and bodies. Their bodies and minds function very differently from adults. Medications and treatments are all prescribed based on the child’s body weight. They also cross different developmental stages at different rates on their way to becoming adults.

For the past 7 years, I have been working at a very busy family practice, caring for all types of patients with all types of concerns, from birth to the very elderly. I work with a family physician who also specializes in transgender care and sexual health. I have seen, assessed and cared for countless adult transgender patients. They comprise a combination of male-to-transgender and female-to-transgender patients.

Almost 5 years ago, my youngest (then 16) daughter expressed to her dad and me that she “thought she should be a boy”. That was the day our family life changed in ways we never anticipated. Throughout childhood, our daughter never presented as stereotypically “masculine”. She never outwardly expressed to us any kind of discomfort. She appeared to be mostly happy. A bright spark. She loved to play outside: doodle with chalk on sidewalks, sandbox play, climb trees, ride bikes. She smiled often. She loved building with Lego, playing Polly Pockets and with tiny toy horses. She enjoyed making tiny crafts, including models of people and animals made of Sculpey clay.

She was also very academically smart, reading beginner short novels before entering Grade 1. She taught herself how to tie her shoes and how to ride a bike. With the help of her father, when she was about 8 years old, she built one amazing bicycle from two used bikes purchased at a garage sale. In Grade 4 she challenged a Math unit about fractions and passed the final exam with flying colours, even before the unit began. She was musically advanced, playing beautiful piano tunes at age six, wonderful tenor saxophone solos in junior high. We had her tested for giftedness by a school psychologist. He told us that she was “just below” the gifted category.

We parents did begin to notice some general, social discomfort in late junior high, but we assumed that this was normal teen awkwardness, which can happen during puberty, so we were not concerned about it. We were absolutely blindsided by her proclamation that she thought she would be a boy.

My older daughter never had a temper tantrum when she was a toddler. I thought it was down to good parenting. How wrong I was. When our younger daughter was born, she behaved quite differently from her sister. Different personalities, which was not surprising to us because my husband and I are also very different from each other. Our youngest daughter started having temper tantrums at 18 months of age, which lasted 4 long years. Then, it was like a light switch turned on. Suddenly she realized she could settle her emotions down by reading quietly, alone on her bed. After just over 4 years of a frequently chaotic time, our house and family seemed to be at peace again. It was lovely.

Thinking back to this time in early childhood, I thought my daughter’s gender discomfort might be a similar phase for her. I still think it might be. I pray that, with time and life experience, she will develop an acceptance and comfort about her female body, and a knowledge that being the female sex does not have to place limits on her happiness and what she can accomplish in life.

drawing-testosterone-injectionBefore daughter told us she thought she should be a boy, I had already seen and assessed countless adult transgender patients. They comprised a combination of male-to-transgender and female-to-transgender patients who ranged in age from late 20s to early 50s. I admit that I when I first started working in family practice, I was very naïve about what “transgender” means. I noticed that all of the adult transgender patients I met also had comorbid mental health issues, which had not been fully resolved and, in some cases were severe/debilitating. My professional duty was (and still is) to provide excellent, compassionate nursing care to these patients. My personality is compassionate, empathetic and caring. I learned some of the transgender lingo; for example, “top” and “bottom” surgery. I’ve administered countless testosterone injections. I’ve changed the dressing on the donor arm of a young 20-something female-to-transgender patient who had recently undergone phalloplasty surgery. And now, after I administer these injections, I’ve found myself in the staff washroom, trying to compose myself for my next patient. Watching female erasure (in particular) causes me much sadness, partly due to what is going on with my own daughter. But mostly due to the fact that I am an adult female-born woman.

As I already said—but it’s worth saying again–I was taught that, in all conditions, medical and nursing treatments should always begin with the least invasive way to treat that condition. I was also clearly taught that pediatric patients have smaller, ever changing and rapidly developing bodies and minds, and need to be treated differently from adult patients. I was taught that physical, mental, and emotional development in children is ongoing, well into the early to mid 20s. Because of my knowledge about child development, both body and mind, I don’t understand why the medication Lupron is being given to healthy-bodied children. This medication is approved for use to treat adults with advanced prostate cancer and endometriosis. In children it’s used to slow down precocious (early-onset) puberty. It’s only in the past few years that it’s being prescribed for children who have gender dysphoria. This is an off-label use for this drug and it’s being given to healthy-bodied children even though there has been no research done to determine its safety or efficacy regarding gender dysphoria.

And we know that puberty blockers lead in most cases to cross-sex hormones. Why is the current first-line treatment for gender dysphoria in young, healthy bodies off-label, unstudied cross-hormone prescriptions? Young adult females can go into a family doctor’s office, state “I’m transgender”, and be handed a Rx for Androgel. This is what happened with my daughter, over a year ago. She never filled that particular prescription. However, last week she notified her father and me that she plans to start taking testosterone. She’s in a lengthy queue to be seen by our city’s gender specialist/psychiatrist and is impatient. She gave us no concrete reasons for wanting to start taking testosterone. She demonstrates little outward discomfort when she is in our home or when interacting with extended family.

She had one visit with the same family doctor who gave her the previous Androgel Rx. She told us that he told her what side effects could occur (while reading from a computer screen). She told us that he did not discuss reproductive planning with her, and that he gave her no written information about any of the side effects. She told us that he gave her the prescription and some bloodwork requisitions. This family doctor did not take a multidisciplinary team approach; he acted on his own. He did not refer her to an endocrinologist to check her hormone levels. He did not send her to any mental health professional, who could have assessed her for the source of her discomfort and possibly provided her with other less-invasive treatment options, such as cognitive behavioural therapy. How is the way in which this family doctor gave my daughter this off-label cross-hormone prescription medically ethical? In my province, family physicians can be the primary prescriber of cross-hormones. While using a multidisciplinary approach might be a good practice, it is not mandated. I’m currently trying to find answers via our provincial and national medical associations. The answers I’m looking for aren’t forthcoming.

I know that in no other medical or other health-related case would something like this happen, with regard to the prescription of off-label medications. I’d like to give you another home-based, common-sense example: Young adult child says to parent: “I have a really bad headache.” Think about this. Would it make any sense for the parent’s first response to be, “Your dad has some leftover oxycodone from his recent surgery, which he no longer needs to take- here, have some!”? Of course not. What would make medical/practical sense would be to first check that the young adult isn’t dehydrated. It is known that dehydration can cause headaches. “Try drinking some water and see if you feel better”. That would be the least invasive thing to try at first. If drinking water didn’t help the headache and if the young adult child had no know allergies or health conditions, it would be appropriate to next offer them acetaminophen, dosed per the package instructions. It is known that acetaminophen is a very effective analgesic, with a low incidence of side effects. If the headache persisted, perhaps it would be appropriate to then try a non-steroidal anti-inflammatory, such as Advil. There might be some inflammation in the neck or jaw muscles, causing the headache, which, if reduced, could relieve the headache. It is known that Advil is a mostly safe anti-inflammatory medication, with low potential side effects.

Recently I attended a Medical Education Session, which was held at a recent clinic retreat. The session was about low testosterone levels in adult males and testosterone replacement therapy. What I learned is, that for male bodied patients, the recommendation is that if the testosterone bloodwork result is low, it is important to clearly understand the patients’ symptoms concerns and general health. If the patient’s symptoms are low and the patient is not concerned, then giving the patient a prescription for testosterone is not advised. This is because there are also many side effects that can happen from taking testosterone, which can cause negative symptoms/concerns for the patient–especially if these male-bodied patients also have other health concerns. I learned that this is appropriate safe medical care for male-bodied patients.

I’ve done my own learning about testosterone. The pharmacy companies’ printed drug information about testosterone products states that this medication should not be given to women. It has never been studied in female bodies. Also, there are no long-term studies which indicate safety or a positive result for females who take this medication. Physicians are prescribing it “off label”.

I have been trying to learn as much as I can about gender dysphoria and its treatment. I have read many studies, documents, medical association websites, etc., and continue to do so.

When I learned about the newly recognized “rapid onset gender dysphoria”, I realized that much of its description matched what we were/are witnessing in our youngest daughter. Currently there is little known regarding care or treatments for young people presenting with rapid onset gender dysphoria. And few physicians are even aware of this phenomenon. There has been a dramatic increase, over a short period of time, in the number of teens and young adults who are seeking care for being transgender. And the demographic for which sex is declaring transgender has also changed. There are now more natal females than males with this concern.

With all that I have learned about rapid onset gender dysphoria and current treatments for it, I have more questions: Why are these off-label testosterone prescriptions being given to young healthy-bodied female patients as a first-line treatment for gender dysphoria? Especially since it is known that testosterone causes permanent body changes in female bodies, making it an invasive and irreversible treatment. Why are physicians prescribing these off-label cross-hormones without doing further assessments to ensure that this is the best treatment for their patients? I believe these are reasonable questions to ask. I believe these are prudent questions to consider. It is not transphobic to ask these questions. Many parents are asking questions like these. If you’re a parent wanting to learn more and connect with other parents, you can check out: https://gendercriticalresources.com/Support/index.php


Afterword:

I have recently learned that my daughter has likely started her testosterone prescription already. I found the receipt for it in her room at home, for low dose Androgel, from a pharmacy our family never uses, so I know that she has purchased it. She is currently living away for university, in a city which is a 2-hour drive from our home, studying in an arts program there. She has never told any of our close extended family anything about her gender dysphoria. We all live in the same city and see each other fairly frequently. Our older daughter (a graduate with a degree in Cultural Anthropology) knows and supports her sister’s claims, but that is all.

androgelOur younger daughter had the opportunity over Christmas (two Christmas dinners actually), to tell anyone in her extended family about her plan to start testosterone. She hasn’t said anything to any of them. Nothing about her gender dysphoria. I’m sure that it will be upsetting to many of them. My daughter and I text back and forth. We text about her activities (theatre, parkour). About her classes (she studies hard and gets excellent grades). About her saxophone practice (she recently was accepted into the university’s wind orchestra). I am proud of the person she is. I see so much potential for her to become an amazing woman and I am sad that she wishes to erase her female body. Frankly, I believe that “gender” is a crap concept, which is why I don’t discuss this with her. Ever since she first told us her thoughts, we have been clear in telling her our concerns. It’s up to her to think about what we have told her. We hope that she will undergo some work to understand the source of her discomfort, but we know that the decision will be hers to make. She tells us that she loves us. We have clearly told her that we love her and always will. We financially help support her post-secondary education. We want her to have many good job opportunities. We want her to have a good life and be happy and healthy. I dread her voice changing. I dread seeing her beautiful face change. And I find myself wondering if she actually needs to go through all of this, in order for her to “find herself” and come out the other side. The birth name we gave our youngest daughter means “strong”. I thought this would serve her well. We continue to use her birth name because we have not given up hope. As parents, we were never prepared for any of this. And as a registered nurse, I am very disturbed by all of it.

WPATH & The Advocate aim to suppress new research on adolescent gender dysphoria

by Brie J


On February 20, The Advocate, one of the leading LGBT publications in the US, ran an article which attempted to invalidate data collected by physician and researcher Lisa Littman from parents whose children experienced Rapid Onset Gender Dysphoria (ROGD). The author, Brynn Tannehill, immediately posted the article to the WPATH Facebook page.

Tannehill ROGD WPATH post

In the thread,  Tannehill (along with Jo Hirst, author of the Gender Fairy), suggested The Journal of Adolescent Health should be asked to retract and/or apologize for publication of Littman’s preliminary findings. UCSF’s Dan Karasic, MD (moderator of the Facebook page and WPATH official) agreed.

Littman’s abstract had been accepted for poster presentation and the poster was presented at the March 2017 Annual Meeting. (The full paper has not been published yet, and we look forward to its availability).

karasic retract poster

Note: Interestingly, as of this writing, four days after they were written, the last three comments have been deleted from the original thread.

The dismissal of Littman’s work, and the move to suppress it, is unconscionable. For one thing, some young people (like my daughter)  who experienced ROGD have already desisted. Others, who were supported in procuring medical intervention, have already experienced regret. Many more desisters and detransitioners are sure to follow.

This trend has not gone unnoticed by at least some in WPATH. For example, veteran WPATH clinician Rachael St. Claire, in a Facebook post on January 5 of this year, made this comment (notice that commenting was turned off immediately after St.Claire posted):

WPATH jan 5 2018 detrans therapist

This concern is echoed by UCSF clinical psychologist Erica Anderson, herself a transgender woman, in a recent Washington Post article:

“I think a fair number of kids are getting into it because it’s trendy,” said Anderson, who was married for 30 years and fathered two children before transitioning seven years ago.

I’m often the naysayer at our meetings. I’m not sure it’s always really trans. I think in our haste to be supportive, we’re missing that element. Kids are all about being accepted by their peers. It’s trendy for professionals, too.”

In addition, clinics around the world have noted a sharp increase in the number of girls presenting for treatment in the last few years.

increase in girls

A once-rare condition is now increasingly common. It is surely in the interest of all people who care about gender dysphoric youth to investigate the reasons for the increase, and Littman’s work is an early contribution to this effort.

The ostensible reason given for Karasic et al’s desire to have Littman’s abstract retracted is that the data comes from a self-selected group of parents, culled from websites where such parents gather, in an anonymous survey format, and is thus deemed to be worthless. Yet advocates for pediatric transition constantly promote other survey studies, also culled from “self selected” groups (such as the Williams Institute suicidality survey), as well as research conducted by investigators who only recruit subjects from pro-early transition organizations (such as Kristina Olson’s two studies), with no attempt to broaden their samples to children who are not socially or medically transitioned.

In fact, Littman’s work is the first to study this new presentation of gender dysphoria, and she collected information from the people who know these children and teens better than any transgender advocate, endocrinologist, psychologist, or therapist ever could — their parents.

But you’re not listening to us.

Littman’s study, according to its critics, is contentious for a few reasons, but most notably for using the term “Rapid Onset Gender Dysphoria” as a descriptor for a new kind of trans-identifying youth, primarily natal females, who during or after puberty, begin to feel intense unhappiness about their sexed bodies and what it means to feel/be/present as a woman.

Let me emphasize: What is “rapid onset” in this population is the dysphoria, not the gender atypicality. What distinguishes these young people from the early-onset populations studied previously is that they may have been happily gender nonconforming throughout childhood (though some were more gender typical), but they were not unhappy (which is all “dysphoric” really means), nor did they claim or wish to be the opposite sex. The unhappiness set in suddenly, in nearly every case only after heavy peer influence, either on- or offline.

This phenomenon has only recently been noted by clinicians directly involved in treating gender dysphoric youth, as well as other mental health professionals. While there is no lack of evidence for adolescent emotional and behavioral social “contagions,” Littman’s research is the first to collect data on this phenomenon as it relates to identifying as transgender.

Even though rapid onset gender dysphoria has been noted by other researchers and clinicians who work with these populations, The Advocate and WPATH’s Dan Karasic consider the descriptor “junk science.” In a swift attempt at censorship, Karasic deleted all but one of my comments on the public WPATH Facebook page and then banned me from the group when I asked him to please consider the experiences of young people, like my daughter, for whom gender dysphoria set in hard and fast after being exposed to the idea that her gender nonconformity was in fact a sign of being transgender.

Interestingly, after I was purged, Karasic posted links to both my and my daughter’s stories on 4thWaveNow, and unfounded accusations were leveled against me and 4thWaveNow; since I was banned, I was not able to respond to them.

Interested readers may refer to these Twitter threads should you want more blow-by-blow details:

It is concerning, given Karasic’s reaction to Littman’s research, that he and others evidently leave no room for a teenager to be incorrect about how they are interpreting their feelings, no room for a clinician to be incorrect when recommending transition, and no room for a parent to understand what is going on with their own child. It is narrow minded and short-sighted, especially considering there is no long-term data supporting the benefits of early medical transition for gender dysphoria or consensus from the medical community about best treatment methods.

This lack of consensus, while well known and acknowledged by the international medical community, has been ignored by many transgender advocates, along with the “gender affirmative” recipients of a $5.7 million NIH grant, who, with the help of the mainstream media, have manipulated the public into believing early social transition, pubertal blockade, and early cross-hormone treatment constitute settled science.

To be clear, in “Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study,” a 17-clinic international study published in The Journal of Adolescent Health, the authors explain that:

As still little is known about the etiology of GD and long-term treatment consequences in children and adolescents, there is great need for more systematic interdisciplinary and (world- wide) multicenter research and debate. As long as there are only limited long-term data in support of the guidelines, there will be no true consensus on treatment. To advance the ethical debate, we need to continue to discuss the diverse themes based on research data as an addition to merely opinions. Otherwise ideas, assumptions, and theories on GD treatment will diverge even more, which will lead to (even more) inconsistencies between the approaches recommended by health care professionals across different countries. (372)

I am sure some WPATH members, like the treatment teams in Lieke et al., “feel pressure from parents and adolescents to start with treatment at earlier ages.” I know there are others, besides those reported in Lieke et al. who:

[…] wondered in what way the increasing media attention affects the way gender-variant behavior is perceived by the child or adolescent with GD and by the society he or she lives in. They speculated that television shows and information on the Internet may have a negative effect and, for example, lead to medicalization of gender-variant behavior.

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

It is unconscionable that transgender advocates, and the leading international body concerned with transgender medicine, would seek to quash data that address unsettled and mostly unexplored areas of concern. It is incredibly important that ROGD be included as a research point because the main studies used to justify the use of puberty blockers, cross-sex hormones and surgery in adolescents required “persistent gender dysphoria since childhood” and “no serious comorbid psychiatric disorders that may interfere with the diagnostic assessment” before the patients were eligible for medical intervention. In other words, none of the participants in these treatment studies had adolescent-onset of their gender dysphoria and none of the participants had serious psychiatric issues.

It is a huge leap to assume that an entirely different population of adolescents with a different presentation of symptoms will have the same results as the adolescents in the Amsterdam cohort.  An additional gap in the research is that because all the desistence and persistence studies are about adolescents who had childhood onset of gender dysphoria, the persistence and desistence rates for adolescent-onset gender dysphoria are unknown.

In all areas of medicine, best practices come from intense discussion and research into indications and contraindications, and into risks, benefits, and alternatives. Yet, WPATH’s Karasic, along with the trans advocates who have prominent roles in the organization, appear to believe it is in their community’s best interest to shut down all discussion about contraindications, risks and alternatives. This is inappropriate and undermines the very concept of informed consent.

Furthermore, The Advocate article suggests that Littman’s sample is biased because it gathered data from “unsupportive” parents. This framing is both fallacious and dangerous to gender nonconforming and dysphoric youth. It suggests that the only path for gender dysphoric youth, even those with a rapid onset, is full affirmation including fulfillment of requested medical interventions. It also implies that parents aren’t able to be both supportive and cautious.

I have spoken to some of the parents who participated in the study. Few could be described as “unsupportive.” In fact, almost overwhelmingly, these parents supported their children in thinking about their gender identity and helped facilitate their preferences for atypical gender presentation and interests (taking them for haircuts, new clothing, and so forth). Many sought professional mental health consultations and treatment for their children. But what many of these parents did not support for their underage teenagers were hormonal and surgical interventions. This is an important distinction: Littman’s sample were supportive parents who were unsupportive of a particular medical treatment option.

It is entirely possible to be supportive parents invested in our child’s well-being and not agree to unproven medical procedures for which there is no consensus from the medical community of long-term safety or benefit to the majority of dysphoric youth. However, the loudest voices in pediatric transgender medicine often cite Kristina Olson’s descriptive research about early social transition for children which relies on the methods that they decry as “junk” when used in Littman’s research (targeted recruitment and the collection of data from parents). Kristina Olson recruited her sample from support groups and conferences to find parents who have socially transitioned their children, which might consist only of parents who are supportive of early social and medical transition. So is it an acceptable method for both studies, junk for both studies, or are the WPATH activists simply going by whether they like or dislike the findings?

As all parents know, we can tell when our children are suffering. To remain credible, advocates for gender dysphoric youth and the international organization which claims to be concerned with generating best practices in the field of transgender medicine must acknowledge that ROGD exists and there are some trans-identifying youth who arrive at their identity from external social pressures, and at times, internalized homophobia.

Related to this last point, the WPATH Facebook page wasn’t the only place my respectful questions were deleted. In a comment on The Advocate article itself, I asked Tannehill and Advocate readers to consider the recent research into how homophobic name-calling influences (hint: greatly) children’s perceptions of their gender identity.

brie advocate comment

My comment was swiftly scrubbed from existence. For those interested in reading “The Influence of Peers During Adolescence: Does Homophobic Name Calling by Peers Change Gender Identity?” the full text is here.

Finally, the fact that ROGD is being discussed by the conservative media is not, no matter how many “incriminating” links Tannehill dropped in the Advocate piece, a legitimate reason to discredit the data. The irony is not lost on many 4thWaveNow parents that our stories are covered by media outlets we typically avoid. In this politically charged climate, it is important for researchers, clinicians, and parents to work together to “first do no harm” even when those we otherwise disagree with call for the same cautions.

Clearly, Brynn Tannehill and Dan Karasic do not speak for all members of WPATH. I know for certain that they do not speak for many professionals currently working with gender dysphoric youth who see in their own practices what can only be described as “rapid onset gender dysphoria” in an increasing number of adolescents, particularly girls. Clinicians are aware of the rapidly growing numbers of young people requesting services and the possibility of social contagion; there are those among you who are concerned by the potential for misdiagnosis and the subsequent harm that will come to some of your patients as a result.

It is time for those with concerns to speak out. Please do not allow your ethical and professional concerns to be held hostage by ideology.

Part 2, Cincinnati trans-teen custody case: Legal analysis

by worriedmom and worrieddad

4thWaveNow contributor Worriedmom has practiced civil litigation for many years in federal and state courts. She is joined in this Part 2 legal analysis of the Cincinnati custody case by Worrieddad, also a civil litigator and partner in his law firm. Part 1 (which includes text of the court decision itself) can be found here.


 In re JNS, the Cincinnati “transgender teenager” custody case, has occasioned a great deal of alternately gleeful and fearful reaction. As noted in our previous commentary, however, it is unlikely to uphold expectations on either side.

In view of the concern that some of our readers may have as to the potential application of this case to their personal situations, we thought it might be helpful to answer some of the questions raised by the case and to explore it in a bit more detail (usual caveat here that this is solely for informational purposes and not legal advice, for which you should always seek your own counsel).

Does this case cover my state?

There are three parts to the answer: first, custody and family law matters are classic examples of areas that are largely up to the individual states to decide. In other words, this case was governed by Ohio state law. Unless you live in Ohio, the case is not binding precedent for the courts in your state. Second, custody cases tend to be what we call “fact-specific.” Courts try to come up with the best way of handling the particular child and family’s circumstances: and as those will vary tremendously from family to family, even in Ohio the case may be of limited application. Third, although federal statutory and constitutional law protections and limitations are germane in certain transgender/custody cases, In re JNS did not decide any such issues.

How did the case get before the judge in the first place?

This is worth exploring in some detail, again because although it raises the specter of unbridled governmental interference in intimate family matters, it also appears that it treats an unusual situation (one unlikely to confront most of our readers).

The matter apparently began in November of 2016, when JNS emailed a crisis hotline, claiming that “one of his parents had told him to kill himself” and that his parents had refused to obtain counseling that was not “Christian-based.” (Note that some of these details are taken from news coverage of the case rather than the court papers themselves – a highly preferable source but one that is not currently available.) At some point prior to the November email, JNS had been hospitalized at the Cincinnati Children’s Hospital Medical Center (“Children’s Hospital”) for at least four weeks. (Id.) Clearly, then, JNS had been in great distress, in that a four-week psychiatric hospitalization is comparatively rare, especially for a teenager.

After the hotline email, in February of 2017, the Hamilton County Job & Family Services (“HCJFS”) stepped in and filed a petition to be granted temporary custody of JNS. Significantly, to avoid the necessity of a hearing (which would, of course, have been emotionally difficult for both JNS and JNS’ parents), the parents apparently agreed “to abide by a pre-existing ‘Safety Plan,’” in which JNS resided with JNS’ maternal grandparents as JNS had been doing prior to this hearing. At this February 2017 hearing, and as is customary in these types of contested matters, the court appointed a guardian ad litem (“GAL”) to represent JNS’ interests before the court.

Did the parents “lose custody” of JNS?

Yes (with qualifications). After the February 2017 hearing, the parties returned to court in April of 2017. At that time, the parents agreed JNS would be placed in the temporary custody of HCJFS and it was ordered that JNS would remain in the grandparents’ physical custody. All the parties agreed on the “permanency goal” that the grandparents would “guide [JNS] to adulthood.” The parents also declined “reunification services,” which would have prepared the parents and JNS for JNS to return and live at home.

Following that hearing, the Children’s Hospital filed “case plans” indicating its desire to initiate hormone therapy with JNS. However, in the court’s words, Children’s Hospital then “inexplicably” withdrew these case plans, and the matter proceeded to magistrate review for determination of the legal custody. In August of 2017, HCJFS filed a petition, seeking to terminate its own temporary custody of JNS, and to place legal custody with the maternal grandparents. In October of 2017, the magistrate conducted an “in camera” (confidential) interview with JNS; this was then followed in December of 2017 with petitions for legal custody filed on behalf of the maternal grandparents. Three days of trial ensued (in and of itself, an extraordinary expenditure of legal energy and judicial resources).

It is noteworthy that at every point during the proceeding, JNS’ parents apparently agreed that physical custody of JNS should remain with the grandparents (this was JNS’ wish as well). JNS’ GAL also agreed that the grandparents should have legal custody. This is significant because the recommendation of the GAL, as the “eyes and ears of the court,” typically carries great weight.

At the end of the proceedings, in the final decision entered on the matter, the court transferred legal custody to JNS’ grandparents. The grandparents are now empowered to consent to a name change for JNS and are obligated to provide medical insurance coverage.

The most significant issue, and the one that presumably concerns most parents, is the question of who will make medical decisions on JNS’ behalf. As noted, while the court ordered that the grandparents will be entitled to make medical decisions, the fact that it placed the condition of an independent evaluation on the grant, together with the fact that JNS will shortly turn 18 years of age, in practical terms means that the only person making medical decisions for JNS will be JNS. Moreover, the court’s decision primarily reflected the reality on the ground, that JNS had been living with the grandparents, by the consent of all concerned, and that JNS was never (while a minor, at any rate) going to return to the parents’ home. Practically speaking, during the short pendency before JNS turns 18, legal custody would either have stayed with HCJFS, or gone to the grandparents.

Did the court endorse medical transition for JNS and/or other young people?

Absolutely not. In fact, the court noted the “surprising lack of definitive clinical study” to support the advisability of any given course of treatment for gender dysphoria. The court also mentioned with “concern” that “100% of patients presenting to the Children’s Hospital are apparently considered appropriate candidates for gender treatment.” Interestingly, the court seemed to indicate some skepticism when it stated that after JNS was referred to the Children’s Hospital for treatment of anxiety and depression, the diagnosis “rather quickly” became one of gender dysphoria, and that the parents were “legitimately surprised and confused” at that sequence of events.

What about suicide?

This case is also significant for what it says about the “suicide issue.” The court did not appear pleased about the parties’ conflicting claims in this regard, stating that JNS’ medical records, as of the end of January 2017, indicated that suicide was not a factor. However, the “very next week,” when HCJFS first moved for custody of JNS on an emergency basis, it was claimed that JNS was, in fact, suicidal – and then more medical records, dated the week after that, stated that JNS was not. The court was understandably aggrieved by this apparent lack of consistency (if not transparency).

cincy court case part 2Interestingly, the court noted the potential future use of threats of suicidality in such proceedings, questioning whether minors might thereby be able to obtain desired medical procedures such as rhinoplasties or “similar cosmetic surgery.” The court also indicated that it should not permit such threats to govern the disposition of cases before it.

What is the likely lasting impact of In re: JNS?

We do not believe that the case has (or should have) any substantial effect for medical practitioners or parents. As discussed above, the court did not endorse or validate medical transition; in effect all it did was delay the process for a few months until JNS turns 18 and will be the sole arbiter of JNS’ decisions. It was not before the court to make any decisions about medical gender treatment that extend anywhere past the extreme facts and circumstances relating to JNS and JNS’ unfortunate family situation. Moreover, nothing in this case stands for the proposition that either obtaining, or refusing to obtain, “gender confirmation” treatment for a child is abuse, reportable or otherwise.

Although the court did not mention it, at present there is no “bright line” test for when a young person becomes legally competent to make his or her own medical decisions. Courts are gradually recognizing that children under the age of 18, who “demonstrate maturity and competence,” should have a voice in making their own medical decisions. It is, therefore, unsurprising, that the court weighted JNS’ wishes in determining JNS’ own “best interests.”

What’s the takeaway?

If we were to make any recommendations to parents based on this case, they would be:

  1. Seek competent, experienced counsel at the earliest possible stage of any proceedings that could potentially involve custody or child welfare issues.
  2. The press coverage of the case refers to allegations of religious animus, although it is noteworthy that the court made no reference to this subject – evidencing that those allegations played no part in the court’s reasoning.  We caution our readers that religion can play a tricky role in these types of cases (and of course we do not condone the making of any cruel comments, whether motivated by religion or otherwise).  While Wisconsin v. Yoder and its progeny stand for robust protection of parents’ religious values vis-à-vis government intervention in family matters, religious concerns, if present, often take a backseat in the eyes of the court as compared with scientific and medical evidence.
  3. Know what you’re getting into when you seek psychiatric care for your child or teen. In this case, a referral for anxiety and depression “quickly turned into” a diagnosis of gender dysphoria. Forewarned is forearmed.

It’s not conversion therapy to learn to love your body: A teen desister tells her story

Update 28 August 2019

At her request, we have removed our interview with Maxine. She told us:

“I’m still happily desisted from my former trans identification. In fact, I have moved on to the point that I am no longer interested in talking or even thinking about ‘gender.’ My life is full and rich, and I’m very glad I did not medically transition. But I am a private person, and at this time, am no longer willing to share my very personal story with the world via the Internet.

 

I wasted a lot of precious time believing I was trans. At the time of this interview nearly two years ago, I was very angry about that, and wanted to help other people, so I wasn’t thinking about my privacy.

 

I’m really glad that sharing my story helped other young people become more comfortable with their bodies. Best wishes to all.”

Moving on

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

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


by Potentilla

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

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

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

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

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

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

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

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

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

The Curse of Trans

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

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

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

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

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

glowing heart

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

Sense of Self

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

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

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

1) Leaving the Trans Cult

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

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

2) Going off Hormones

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

medicinal herbs

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

3) Detransition

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

Some Closing Thoughts

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

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

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

Too much trust

4thWaveNow contributor Overwhelmed is the mother of a daughter who previously identified as transgender. Her daughter is now comfortable being female even though she chooses to eschew conventionally feminine clothing and sports a short haircut.

Overwhelmed can be found on Twitter: @LavenderVerse


by Overwhelmed

Why does the public seemingly trust that gender doctors know what they are doing? Well, one of the reasons is the frequent media portrayals of trans kids. Children who have recently undergone medical transition are being presented as success stories, even though no one knows the long term consequences of gender-affirming treatments.

I came across this article on the University of California San Francisco website. It covers the transition of three children—two who have puberty blocker implants and one, a natal female named Oliver, whose treatment has included puberty blockers, testosterone, a double mastectomy with chest contouring, a hysterectomy (at 16 years old!) and plans in the near future for the first in a series of phalloplasty surgeries. The article also highlights the involvement of three gender-affirming pioneers—Dr. Ehrensaft, Dr. Rosenthal and Joel Baum—whom I will discuss a little later in this post. But first I will focus on Oliver.

Oliver’s story (which I’ve pulled from three separate articles) starts off as expected—a young child uncomfortable in dresses who likes short hair and playing baseball. When puberty started, it caused a great deal of distress. Suicide was considered. And then:

A few months before his 15th birthday, …stumbled across the word “transgender” online. He read about people who had had medical treatment to align their bodies with their gender identity – their inner sense of who they are.

“Bam, my life changed,” he says. “It lifted a major weight to find out I could do something about all this pressure I had been feeling.”

 At first Oliver’s parents, especially his father, didn’t accept that their daughter was really their son.

“It took me a bit to become a really supportive dad,” ….

For months they didn’t speak. But in the end, reading the suicide statistics for transgender teens brought him around.

“My kid’s not going to kill himself,” …. “I don’t care what he is, as long as he’s a productive person in society, and he needs all the support we can give him.”

Oliver was taken to UCSF’s Child and Adolescent Gender Center.

By age 15, Oliver… was on a dual regimen of testosterone, plus puberty blockers to keep his endogenous estrogen from competing with the male hormones.

While he had to endure a second puberty, and he’ll need to take testosterone for the rest of his life, he’s had no second thoughts about transitioning.

The summer after his sophomore year, he had “top” surgery – a double mastectomy and male chest contouring – in San Francisco. To pay for the procedure, which was not covered by insurance, he used earnings from years of showing and selling pigs at the Tuolumne County fair.

“It’s a lot of money for a 15-year-old,” he says of the $8,000 price tag. “But I appreciate it every day.”

His family’s insurance also wouldn’t cover a puberty blocker implant, so… at first chose cheaper but “gnarly” monthly shots. Later, concerned about unknown long-term effects of the blockers, and hating the painful shots, he opted for a hysterectomy at age 16 – performed by the same family doctor who had delivered him.

In June, he’ll undergo the first in a series of “bottom” surgeries to create male genitalia.

His only regret, he says, is not finding UCSF’s Gender Center sooner. “To not go through the wrong puberty, those kids are lucky,” he says. “That’s a team effort. You have to show [gender dysphoria], and parents have to catch it.”

Oliver’s story has been published in at least three media articles, likely reaching a large audience. The teen has also been influential in Oliver’s small town high school  where at least four other transgender students have since come out.

ucsf-logo

An increasing number of children like Oliver are announcing they’re transgender, and families are looking to the experts in the field for guidance. Diane Ehrensaft, PhD, a clinical and developmental psychologist, is one of a number of pediatric gender-affirming pioneers in the San Francisco Bay area. She is Director of Mental Health and founding member of the UCSF Child and Adolescent Gender Center. She is a well-known proponent of the gender affirmative model and has authored two books on the subject. Ehrensaft has a private practice in Oakland and serves on the Board of Directors of Gender Spectrum.

Her credentials seem impressive, but there are concerns that her stance could unnecessarily pressure parents into eventually medically transitioning their children. She’s often quoted in news reports about trans kids. Here she is in the Duluth New Tribune article from above, rationalizing the dramatic increase in trans-identifying kids seeking treatment:

“We have lifted the lid culturally,” said developmental psychologist Diane Ehrensaft, whose Oakland, Calif. practice has seen a fourfold increase in the number of gender-questioning kids in recent years. “These kids have always existed, but they kept it underground.”

She is also quoted in the UCSF article:

“When a child says, ‘I’m not the gender you think I am,’ that can be a showstopper,” says Diane Ehrensaft, PhD, the Gender Center’s director of mental heath as well as a private-practice psychologist in Oakland. “Some parents say, ‘Not on my watch. No way am I signing off on a medical intervention. When they’re 18 they can do what they want.’ I say, ‘You’re absolutely right, you’re the ones minding the shop, but let me share with you the risk factors of holding back.’”

A parent swayed by Ehrensaft’s logic may believe that, contrary to historical records,  there were always this many trans kids. This could lead parents to disregard the impacts of social contagion. And she tells parents that being cautious and holding back medical interventions until their child is 18 could lead to serious “risk factors.” Suicide seems to be implied.

Stephen Rosenthal, MD, is another pediatric gender-affirming pioneer in the San Francisco Bay area. He is a founder of the UCSF Child and Adolescent Gender Center and currently serves as its Medical Director. He is also the program director for Pediatric Endocrinology, director of the Endocrine Clinics, and co-director of the Disorders of Sexual Development (DSD) Clinic. Additionally, Rosenthal spends time as a professor of clinical pediatrics at UCSF and conducts research. Currently, he is participating in an NIH-funded study of pediatric medical transition.

He has stated that “these kids have a very high risk of depression, substance abuse, suicidal thoughts and suicide attempts. Not treating is not a neutral option. He promotes early treatment—puberty blockers, cross-sex hormones and sometimes surgeries—to alleviate these symptoms without any proof of long term relief.

Under his direction, the UCSF Child and Adolescent Gender Center has grown substantially. It opened in 2010. By 2012 there were 75 patients and currently there are over 300 patients with about 10 new referrals a month. Business is booming. Clinics are being added in San Mateo and Oakland. The UCSF Gender Center network isn’t the only place in the San Francisco Bay area offering pediatric gender affirming treatment. Stanford and Kaiser Permanente provide similar services.

What could be driving all of these children to seek treatment? Well, the San Francisco Bay Area has been well-educated by Gender Spectrum, a “national advocacy group for gender expansive youth whose mission is to create a gender sensitive and inclusive environment for all children and teens.” Many schools in the area have hosted training sessions by Gender Spectrum. The goal of gender sensitivity training is to increase acceptance and decrease bullying, but it’s likely that some children get confused by the information, leading to a rise in referrals to gender clinics.gender-spectrum-logo

Joel Baum, MS, is an advocate for pediatric gender affirmation. He is the Senior Director of Professional Development and Family Services at Gender Spectrum and is the Director of Education and Advocacy for the UCSF Child and Adolescent Gender Center. He co-wrote Schools in Transition, A Guide for Supporting Transgender Students in K-12 Schools, which I discussed in this blog post. He has spoken in schools, at conferences (mentioned in this 4thWaveNow post) and, according to this article, promotes transgender awareness on radio shows.

Per the article, it was Baum who helped Emily and her husband realize that their son was really their daughter (Kelly).

One day Emily got a call from her husband, who was in his car listening on the radio to Joel Baum, MS, the Gender Center’s director of advocacy as well as the director of education and training for the Oakland-based nonprofit Gender Spectrum. “You’ve got to turn on the radio,” he told her. “I think this is our kid.’”

Emily was horrified to learn about the high rates of harassment, school failure, and suicide among transgender youth. “I couldn’t talk about it without weeping. I kept going to all these images in our culture for transgender people, that they’re on the edge, disenfranchised,” she says. “I was thinking, ‘I can’t lose my kid. I don’t care what her gender is. I’ve got to get on the other side of those statistics.’”

Her path forward, she says, was “unconditional acceptance of my child’s truth.”

The family started regular visits to Gender Center clinics and let Kelly be their guide. She grew her hair long. In third grade, she switched her masculine birth name to a gender-neutral nickname. At age nine, she transitioned socially, becoming “she” to relatives, friends, and classmates.

Intensely private, Kelly wanted no emails to parents, no classroom announcement. Just a quiet switch in pronouns. Her elementary school administrators and teachers – faced with their first transitioning student – were “incredibly supportive,” says Emily, who sought out staff training and put Kelly in a classroom with only one student who knew her from “before”: her best friend.

Now 13, Kelly has a matchstick-sized implant under the skin near her left bicep to suppress the male hormones her body produces. She’s blossomed into a “beautiful, smart, artistic, empathetic, fun kid,” Emily says. “I’m like, ‘Whoo! I hit the jackpot.’ But it was definitely a process and a journey for our family, and our daughter, to come to understand who she was.”

Ehrensaft, Rosenthal and Baum are promoting treatment for gender dysphoric children based on unproven theories, not solid evidence. There has been a dramatic rise in trans-identifying youth, but instead of questioning why, Ehrensaft says that the increase is due to hidden trans kids coming out. Rosenthal seems to believe that pre-emptive treatment (leading children to become permanent medical patients with unknown long term side effects) is worth it to potentially avoid future depression, substance abuse and suicide. Baum doesn’t appear to consider that transgender advocacy can lead some impressionable kids to mistakenly self-diagnose as trans. Or, that it can affect how parents interpret their children, potentially leading their gender defiant kids unnecessarily down the path of transition.

And each uses suicide statistics, flawed as they are, to justify early intervention. I’ve seen many parents in news articles state that the motivation to go along with transition was to avoid suicide. Parents are scared and feel pressured. They want to keep their children alive, no matter what. They don’t feel like they have a real choice. “I can either have a live son or a dead daughter” (or the reverse) is a common saying. When parents trust the advice of gender experts, they will accept puberty blockers, cross-sex hormones, mastectomies, and hysterectomies as necessary. Unfortunately, though, this approach does not guarantee a live child.

Tremendous pressure is being placed on parents to provide gender affirmative “support.” Media articles never quote these pioneers recommending what we do at 4thWaveNow—to support our children in defiance of gender. We allow our children to choose their haircuts, clothing and interests. We accept them as is, without pressuring them to conform to societal expectations. We urge caution and encourage reflection on what it means to be male or female. We consider the long term impacts of medical interventions. We don’t rush into gender affirmation via pronouns or treatments. We want to avoid suicide in our children, but realize that the underlying reasons are more complex than the trans kids media articles portray. And some of us have had success with this approach.

There is a great deal of trust being put in the experts in the field, but we need to remember that they are pioneers in the strictest sense. They are still developing new ways of thinking about and treating gender dysphoric patients. The process is not complete. Gender science is rapidly evolving and changes to treatment protocols are likely. Today’s success stories may not be tomorrow’s success stories. The trust in experts should be viewed from this perspective.

Gender-affirmative therapist: Baby who hates barrettes = trans boy; questioning sterilization of 11-year olds same as denying cancer treatment

Note: 4thWaveNow frequently features posts (like this one) that focus, often unflatteringly, on the activists and providers involved in pediatric transition. These people aren’t ogres who intend to bring harm to the young people and families under their care and influence. They undoubtedly sincerely believe they are doing the right thing. The purpose here, as ever, is not to demonize, but to shed light on the potential and actual damage done by the practice and ideology of “gender affirmation.”  Harms done not only to children and their families, but to the decades of progress achieved by the women’s and LGB liberation movements.


A well known subscriber to the “gender affirmative” approach to trans-identified children is Diane Ehrensaft, PhD., a clinical and developmental psychologist. Dr. Ehrensaft, author of The Gender Creative Child, plays a powerful role in the burgeoning field of pediatric transgenderism. She is director and chief psychologist for the University of California-San Francisco children’s hospital gender clinic, and is also an associate professor of pediatrics at UCSF. She sits on the Board of Directors of Gender Spectrum, a San Francisco Bay area organization which is heavily involved in matters pertaining to trans-identified children and youth.

In February, Dr. Ehrensaft, along with other pediatric transition specialists, including Joel Baum, MS (senior director of professional development and family services at Gender Spectrum), presented at a conference and continuing education event in Santa Cruz, California.  The all-day event, attended by over 400 people, was recorded and video is available here.

The 5.5-hour video is well worth watching in its entirety for anyone interested in the current state of “gender affirmative” therapy. This post will touch on only a few highlights from the conference. There is much, much more.  (Numbers in square brackets give approximate hour:minute time stamps for each video excerpt.)compare-models

Dr. Ehrensaft [1:31] tells the audience that “gender affirmation” differs from the more cautious approach of learning to “live in your own skin” provided by Dr. Ken Zucker in Toronto. Zucker’s clinic was shut down by trans activists a few months ago—reported by Ehrensaft with obvious glee and to the applause of her audience. Gender affirmation also parts company with the “watchful waiting” protocol pioneered by clinician-researchers in the well known Amsterdam gender identity clinic founded by Peggy Cohen-Kettenis. The Dutch have repeatedly counseled caution in social transition and early intervention for gender dysphoric children, given the high rate of desistance and the fact that early social transition has made it more difficult for some young people to change their minds later—and might even increase the likelihood that a child will persist in a trans identity.

kid-tells

Ehrensaft labels “gender affirmative” therapy as “listen and act,” i.e., essentially follow the child’s lead in whether or not to proceed with early interventions like social transition and puberty blockers.  According to Ehrensaft, this boils down to whether the child says they ARE (vs. “want to be”) the opposite sex, and how “persistent, insistent, and consistent” they are in asserting their cross-sex identification and gender “expression.”

Ehrensaft denies that gender-affirmative therapists simply “rubber stamp” a child’s gender identity, yet despite her protestations to the contrary, she constantly reifies the idea that gender identity is innate and recognizable even in pre-verbal babies and toddlers (more on that later in the post).

rubber-stamp

To be fair, in her presentation Ehrensaft does acknowledge the replicated research showing that a large majority of gender dysphoric kids will grow out of it. Yet she strongly believes that she and others like her can reliably distinguish between the “apples” who are truly transgender and the “oranges” who are only exploring.

Even if you believe there is such a thing as a truly transgender child, what is the justification—the evidence— for her hubris, her certainty that she and others like her who peddle the “gender affirmative” approach can predict which children might be happy, decades later, as sterilized, surgically and chemically altered adults? There really isn’t any. Even so, at one point, she claims science is on her side, pointing (without directly citing it) to “research” out of the University of Washington that proves—gender-defiant children really, really, really mean it when they say they prefer the clothes, toys, and lifestyle more typical of the opposite sex.

Let’s take a closer look at the “insistent, consistent, persistent” mantra—droned incessantly by gender experts, with this conference being no exception. While Ehrensaft and Baum take great pains to say they support and even celebrate gender “nonconformity,” when the young trans-identified people (present at the event and on video) talk about their experiences and how they “know” they are trans, we hear the same rationale we always do: they eschew sex-stereotyped behaviors and appearance.

How does Ehrensaft directly instruct us in what it means to be “consistent, persistent, and insistent”? She plays a video clip of a young FtoM who has this to say about why s/he is and has always been trans: [47:00]

 We [trans kids] don’t know about much but we know about gender. We know that girls are the ones supposed to be in skirts and dresses and guys in jeans and fight all the time…I think what should have been a sign to my parents was um…I was a quiet child. I didn’t fuss or anything. But whenever my mom would try to dress me up and put lipstick on me and get me all pretty for pictures I would throw a tantrum, I would scream … that should have definitely been a big sign to her that I was not trying to fit into the girl role… The most feminine thing I did as a child was paint my nails—black.

There is knowing laughter from the audience at this last point—as if choosing black (instead of pink or purple?) fingernail polish were a sure sign that this child was, in fact, a boy.  A child who was, yes, persistent, consistent, INSISTENT…that she didn’t want to act like a stereotypical girl in a dress wearing lipstick.

persistent-teen

If Ehrensaft could respond here, I imagine she might say something like, “oh but it’s more than gender expression!” If it’s more than that, why is the one video excerpt provided to teach us about who is really trans all about stereotypes? Could it be that conforming to stereotypes is the very basis of the definition of a “trans child”?

We hear from another trans-identified teen during the panel discussion, Jordan, a 17-year-old FtoM. We also hear from Jordan’s mom, Heidi, who leads a local support group for trans-identified youth and their families.

Heidi—who at several points mentions her strong church affiliation–talks about some of the childhood experiences that convinced her that her daughter was actually her son, including this [4:37]:

 When Jordan was about 2 it became clear to me that Jordan liked boy things—you know trucks, video games, violence…when he was about between 2 and 4 I noticed he would rip off the pretty little dresses I would put on him. Would go screaming through the house and would not leave the house until he had on his brother’s big, holey T-shirts. I just thought he was a tomboy and that it was a phase.  He was driving me nuts but it was a phase. During this time I worked for a very large church… We are Christians… We were told by everyone around us to make that kid wear a dress.

Another kid screaming in a dress.

Mom tried to force her kid to wear dresses: check. The kid liked trucks: check. A girl not wanting to wear dresses is ”a phase”: check. Mom didn’t like this (it drove her nuts): check. Mom was involved with a church, whose members wanted her to “make” her child wear a dress.

Could this stuff be any more obvious?

Jordan seems to agree that an aversion to wearing dresses is a key sign of one’s innate gender identity [4:44].

 My mom put me in a dress at Easter.  [But I] went to church in dirty jeans and a big T-shirt. That was kind of a big signal.

A big signal of what? That Jordan didn’t like dresses, preferred to wear jeans? What is this obsession with dresses that we see in each and every media story about girls who are “really boys?” When did we step into this time machine, returning to the turn of the 20th century? Even Katherine Hepburn wore pants and eschewed dresses in the 1940s.

Then there’s this from Heidi [4:40]:

[During the elementary school years] I was [putting up] posters of really strong women. You know, like the singer Pink? Oh, this is a real kick-ass girl, you can be like her… when he had a crush on her. It was things like that.

Things like… not wanting a lesbian daughter? This conference took place in 2016, in the San Francisco Bay Area–for decades considered one of the most gay-friendly places in the USA, and the audience tittered at this revelation of Jordan’s same-sex attraction—as if that were a sign Jordan was actually a boy!

Mom goes on to describe how Jordan was diagnosed with a whole “plethora” of mental health issues, from ADD to bipolar to mood disorders, and concludes that it was being trans that was the root of all these other problems; once Jordan transitioned, everything else cleared up: the self hatred, the self harm, the unhappiness.

This is an increasingly common refrain, and in fact, Ehrensaft at several points in her presentation asserts that “gender is the cure” for an array of other mental health issues. What we don’t see, from Ehrensaft or anyone else, is actual evidence that allowing children to “transition” results in improvements in mental health over the long haul. What we are beginning to see in accounts from some people who have detransitioned is that transition essentially put their other issues on hold for a while—only to re-arise when the initial transition exhilaration began to dissipate.

We have evidence from several studies that gender dysphoria often co-presents with other mental health issues. Ehrensaft and others like her are now turning such research on its head, positing that the cause of comorbid mental health problems is a child being somehow thwarted in their gender identity.

Returning to the conference, although Jordan’s “gender expression” is not assumed to be the real reason for transition, it is telling that, as always, it is examples of how a person does or does not conform to sex-stereotyped behaviors that are presented as the evidence for being transgender.

And that goes even for babies, according to Ehrensaft. During the audience Q&A, a man asks how one might tell if a pre-verbal one or two-year-old is transgender. Ehrensaft’s answer, delivered with a knowing and confident smile [Clip for this excerpt is here, starting at approx. 2:05-2:06 in main video]:

 [Preverbal children] are very action oriented. This is where mirroring is really important. And listening to actions. So let me give you an example.

I have a colleague who is transgender. There is a video of him as a toddler–he was assigned female at birth–tearing barrettes out of then-her hair. And throwing them on the ground. And sobbing. That’s a gender message.

barrettes

Ehrensaft miming a significant “gender message:” a toddler ripping barrettes out of her hair

Ehrensaft is a developmental psychologist, and the only reason she can think of that a 2-year-old girl might detest the feel of barrettes in her hair is that the child is really a boy?

Again, I imagine Ehrensaft’s retort: Oh, that was just one thing–there were lots of other signs. Then why does Ehrensaft use this as a seminal example when responding to a question from the audience? And according to Ehrensaft, if the child (consistently, insistently, and persistently?) tore the barrettes from her hair “not once, but twice, three times,” that is the clincher.

Ehrensaft elaborates:

Sometimes kids between 1 and 2, with beginning language, will say, “I BOY!” when you say “girl.” That’s an early verbal message! And sometimes there’s a tendency to say “Well, honey, no you’re a girl because little girls have vaginas, and you have a vagina so you’re a girl…Then when they get a little older [the child] says, “Did you not listen to me? I said I’m a boy with a vagina!

Believers in gender identity accuse gender skeptics like me of “reducing people to their genitals.” But here we have a developmental psychologist saying in so many words that the only thing that makes a girl a girl….is her vagina. I don’t know about the other parents reading this, but I can say my response to my two-year-old in that scenario would not have been a reference to (one aspect of) her genitals.

What else does Ehrensaft advise for parents who are so concerned about their baby’s “gender identity”?

They can show you about what they want to play with…and if they feel uncomfortable about how you are responding to them and their gender… if you’re misgendering them. So you look for those kinds of actions….like tearing a skirt off. …There was one on that Barbara Walters special, this child  wore the little onesie with the snap-ups between the legs. And at age one would unsnap them to make a dress, so the dress would flow. This is a child who was assigned male. That’s a communication, a pre-verbal communication about gender.

Ehrensaft then counsels parents not to try to squelch non-sex-stereotyped behaviors (good advice), but ruins it with a faith-based assertion of innate gender identity:

And children will know [they are transgender] by the second year of lifethey probably know before that but that’s pre-pre verbal.

Not to put too fine a point on it but…this is a PhD. developmental psychologist talking here. What is her evidence base for saying babies “know” their gender identity?

…Especially since, at other points in her presentation, Ehrensaft acknowledges that gender identity can be fluid.

So which is it? A baby innately “knows” their gender identity, or it’s mutable?   To be logically consistent, Ehrensaft ought to also say that some infants are born (innately) “gender fluid”—an assertion that would be much closer to the truth, given the fact of lifelong neuroplasticity.  I wonder when the NIH will fund a study to determine which babies are born “binary” and which “genderqueer”?

What if gender-fluid children transition but change their minds? No harm done, according to Ehrensaft. She breezily asserts [1:50] that there is “no data” that it harms kids to switch back and forth between identities, as long as we “support” them in their “journey”—presumably even if that journey takes them down the road to hormones and surgeries which will alter them forever. She even touts “nonbinary transition” [3:57] as if it is something to be celebrated when youth who define themselves as “agender,” “nonbinary,” or any of the other “genders” (better known as “personalities”) might choose irreversible medical interventions.

Is Ehrensaft aware of cases like this? Would she just chalk it up to this detransitioned woman being “gender fluid” instead of “binary” and the permanent damage done to her body just part of her “gender journey” for which we have “no evidence” of any harm?

My double mastectomy was severely traumatizing. I paid a guy, a guy who does this every day for cash, to drug me to sleep and cut away healthy tissue. I did this because I believed it would heal all of the emotional issues I was blaming on my female body. It didn’t work. Now I’m still all fucked up and I’m missing body parts, too.

Ehrensaft also thinks social media has “been a godsend” [2:08] and a “tremendous boon” for young people to find others like them, with the only real ill effect being the online bullying of trans-identified kids. To be fair, she does throw a bone later to the fact that some kids presenting to clinics may be using a “script” and it’s important to look deeper to see whether it’s “their script”—which is something;  although if Ehrensaft was trained in child/adolescent developmental psychology, her cheerleading for nothing but the positive effects of social media is stunning. Has she never heard about online “communities” of teen anorexics and cutters?

Now to touch upon one final topic covered by Ehrensaft and others in the conference: permanent sterilization caused by prepubescent hormone treatment. This “side effect” is rarely mentioned in the countless media stories celebrating trans kids. One usually has to hunt for obscure literature references to find any mention. But during the conference, several providers do  acknowledge—repeatedly–that puberty blockers followed by cross-sex hormones always result in permanent infertility. They do so at least three times in the conference: [3:53], [4:18], and [5:06].

During the closing panel discussion, Ehrensaft and Baum devote several minutes to the topic of sterilizing trans kids—but explain it away with a twofer: By equating it to treatments for children with life-threatening cancers, and by stating that parents reluctant to sterilize their 11-year-olds are only concerned because they selfishly want grandchildren.

Actually, it’s a three-fer, because Ehrensaft and Baum manage to squeeze in the usual emotional blackmail: children who have to go through their natal puberty might commit suicide. [5:06].

Ehrensaft:

Another thing that’s a show-stopper around [parents] giving consent is the fertility issue. That if the child goes directly from puberty blockers to cross- sex hormones they are pretty much forfeiting their fertility and won’t be able to have a genetically related child.

There’s a lot of parents who have dreams of becoming grandparents. It’s very hard for them not to imagine those genetically related grandchildren. So we have to work with parents around, these aren’t your dreams. [she laughs]. You have to focus on your child’s dreams. What they want.

Let’s be very clear here:  Ehrensaft laughingly implies that parents concerned about their child’s human right to choose or not to choose to reproduce, a decision heretofore seen as inalienable and reserved for mature adults, are really only concerned about future grandchildren, not the bodily integrity or cognitive wherewithal of their prepubescent child. These egocentric parents are denying their children “their dreams.” These thoughtless parents need to be “worked with” by gender specialists.

And that’s not all: Ehrensaft goes on to shame these recalcitrant parents with the implication that puberty-blocked, 11-year-old trans tweens are more socially responsible than their clueless parents:

 And what I will say about many of the youth who want puberty blockers is: I have never met such an altruistic group of kids around adoption! Never! “I will adopt because there are so many children who need good homes.” And I think that’s both heartfelt but also they’re trying to tell us the most important thing to me right now is being able to have every opportunity to have my gender affirmation be as complete as possible. Anything else is secondary.

Do we need a PhD in developmental psychology to tell us this? You bet an 11-year-old thinks anything but what they want RIGHT NOW is secondary.  I want it, and I want it right now: the motto of youth, of children who are a decade or more away from full development of their reasoning, judgment, and awareness of future consequences.

But wait—perhaps there’s hope. Asks Ehrensaft:

The question is, can an 11-year-old, 12-year-old at that level of development, be really thinking and know what they want at age 30 around infertility?

Can they? Might it be ok to wait and allow this child to mature to adulthood before making such momentous decisions?

The answer to that is: We don’t think twice about instituting treatments for cancers for children that will compromise their fertility. We don’t say, we’re not going to give them the treatment for cancer because it’s going to compromise their fertility.

So here we have a woman who is directly responsible for sterilizing 11 and 12 year old children equating simply waiting–allowing a child to grow up to make their own decisions—with denying cancer treatment. And of course, we know what’s coming next: Transition or suicide.

For some of the youth, having the gender affirmation interventions is as life-saving as the oncology services for children who have cancer.

And they must have these interventions right now!

I wonder: Do Ehrensaft or any of the others here, so very certain of their moral superiority, ever lie awake at night wondering whether these children in their care could just as easily be supported in waiting?

baum-threat

Joel Baum instructs parents to transition their kids–or else.

Joel Baum, head of education for Gender Spectrum doubles down [5:09] to deliver the coupdegrâce to any parents who might still be hesitating:

I’ll just add one thing here. When we’re working with families, what is the leverage point for that family?…The fact of the matter is at the end of the day, it is their decision and we just hope they’re going to make an informed decision. Just make sure you have all the information you need. Which includes:

Here comes the punchline—the ultimate “leverage point”:

You can either have grandchildren or not have a kid anymore because they’ve ended the relationship with you or in some cases because they’ve chosen a more dangerous path for themselves.

Here, I’ll just let one of my lovely, unpublished commenters translate Joel Baum’s so-very-subtle veiled threat into plain language:

You are a horrible mother and you are abusing your son. You’re the reason trans people kill themselves. I hope one day he escapes from you and your transphobic abuse and never has to see you again.

Never mind that my daughter desisted from trans identity; never mind that our family remains intact despite my “transphobic abuse” i.e., refusal to pay for hormones and top surgery. And never mind, Joel Baum, that there is no evidence that troubled youth will desist from self harm if their parents are terrified into paying for irreversible medical interventions.

At this juncture, let me repeat what I’ve said many times before: A concern about sterilizing children is not a statement about whether a person ought to reproduce or not.  It’s about respecting the right of children to mature to adulthood to make the decision for themselves. It’s a basic moral tenet, respected in every other area of human rights law: you don’t sterilize children.

And this, too: There is no evidence, historical or otherwise, that a child prevented from medically transitioning will kill themselves before making their own medical decisions as an adult. That activist-clinicians feel justified in holding this threat over the heads of loving parents—and that journalists, politicians, and pediatric specialists who should know better abet them in wielding this weapon—is deeply shameful and should be exposed to the intense, disinfecting light of public scrutiny as long as necessary; until the purveyors of this immoral strategy are finally forced to answer the difficult questions they have been avoiding for the better part of a decade.

This conference is worth studying for anyone who wants to fully understand how a formerly rare diagnosis, with medical treatment only available for legal adults, has morphed into a pediatric specialty area where doctors, psychologists, and psychiatrists wave away the sterilization, drugging, and permanent medical alteration of children with nary a peep of dissent. And they do it by shamelessly scaring the bejesus out of everyone, by shaming parents into believing that unless they permanently sterilize little Judy or Billy at age 11, unless they agree to irreversible medical interventions for their teenager, they will be colluding in their child’s demise.

Watch the entire 5-hour presentation, even if you have to do it over several sessions. What you’ll be observing is how key movers and shakers on the cutting edge of pediatric transition in the United States are moving inexorably forward. Understand their tactics. Understand their ideology.

Because despite its steady progress so far, the “gender affirmative” pediatric transition juggernaut is only beginning to pick up speed.

[Meanwhile, if you haven’t already, be sure to read this post by a therapist who is skeptical of the “identity model” for trans-identified youth.]

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

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

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

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

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

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


by Lisa Marchiano 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

whitman-quote-2

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

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

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

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

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

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

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

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

K-12 schools morphing into indoctrination hubs: Parents share their stories

Seemingly overnight, US public schools have been transformed into no-questions-allowed re-education centers for inculcating the notion that children as young as 4 or 5 years old can be innately transgender, and that any student, of any age, who claims to be or “feel like” the opposite sex is entitled to use not just private bathroom stalls, but shared locker rooms and showers designated for the sex s/he “identities with.”

As a result of this imposed sea change in US school policy, there has been a growing pushback from parents across the nation; the battle is raging fiercely, having recently reached the Supreme Court in one important Virginia case. And yesterday, it was announced that a federal judge had issued a “nationwide injunction” to halt the Obama administration’s directive to open school bathroom/locker room facilities to any student on the basis of their stated gender identity.

The mainstream media continues to (inaccurately) present the issue as between two clear opponents: Right-wing, homophobic and transphobic reactionaries, vs. the virtuous progressives and forward-thinking people who unquestioningly support President Obama’s “guidance” to force public schools into compliance with trans activist demands.  (Regular 4thWaveNow readers will know that most parents who congregate here are of the liberal/Democratic persuasion.)

Parents who have questions about the wisdom of this exercise in social engineering are ignored, marginalized, and even deliberately excluded from decisions about how their children are treated during the school day (and on overnight field trips, as well). A few months ago, 4thWaveNow contributor Overwhelmed wrote a post about the situation in US public schools, and yesterday, a very important post, “Gender Activism in Schools,” appeared on the blog Youth Transcritical Professionals, written by a parent named Emily, who has been embroiled in a battle with her 4th grader’s public charter school and school district.

The brawl at Emily’s school–Nova Classical Academy, in St. Paul, Minnesota–started and then escalated when the parents of a 5-year-old demanded opposite-sex toilet access for their son-now-trans-daughter.  According to Emily’s account, the school went from being a place where all parents’ views were respected, and where they had consistently enjoyed a major role in setting school policy, to a very different situation: a school where administrators and teachers knowingly hide information from parents in the name of adhering to an ideology that may neither be questioned, nor tailored to the needs of all the children and families in the school community—not just those who claim a trans identity.

I highly recommend that you read all of Emily’s post, and then ask yourself: Is this the way major social change should take place in a representative democracy? Should the executive branch subvert the checks-and-balances of the US legislative and judicial branches of government to bend a balking populace to its will?

Here’s a slightly tangential thought experiment. Trans activists are forever comparing their efforts to that of the fight of gay and lesbian people to attain civil rights.  But twenty or thirty years ago, can anyone imagine that adult gay and lesbian activists would have dreamed of demanding that public schools identify and “affirm” those kindergartners most likely to grow up to be gay or lesbian (the adult outcome for most “gender nonconforming” children)?  Back in the halcyon days of the LGB and women’s liberation movements, the idea of bringing children as young as 5-years-old into a discussion about private body parts,  or whether LGB people are “born that way” would have been beyond the pale—let alone any such initiatives being mandated by the President of the United States.

Emily wrote to ask us to reblog her post. We went a step further: We asked parents in our blog community if anyone would like to share their own experiences with their children’s schools vis-à-vis transgender issues and rights. From the accounts we’ve received so far, it’s evident that private schools are also affected, and the situation in UK schools is very similar.

Several of the below contributors (most of whom are not at liberty to identify themselves publicly), as well as Emily, who wrote the original post on Youth Transcritical Professionals, are available to participate in the comments section below.  Please feel free to add your own school-based experiences to the discussion.


Parents weigh in: School experiences


Nervous Wreck says:

My 18-year-old daughter’s very sudden decision to transition only happened after she herself learned as a public high school senior about the whole concept of transgender from classmates. It provided her an answer that made sense to her…a highly intelligent girl who never quite “clicked” with other girls. For her it was the power of suggestion from a classmate. How much more powerful the suggestion might be if it had come from the instructor?

Where I live, the public schools give a presentation to the parents about the sex education/STD materials that will be presented to students in the various grades. Parents are allowed to watch the very same videos that our students will watch, and parents are given the option to opt their student out of these presentations. Our students are not mandated to learn sex education from our public schools. We parents have the choice to teach our own students at home if we so desire.

Why is it not the same with gender identity materials? Are the health instructors expected to teach these materials as scientifically proven when it is not? Even if I didn’t opt-out of these materials, I want to know what the schools are teaching so I have the opportunity to have my own discussion with my child.

This all makes me sound terribly conservative doesn’t it? But I’m a life-long Democrat. I just happen to have a spiritual life that helped me as a youth to accept that our bodies are a gift to accept as is, simply a vehicle for carrying our spirit around. One does not have to be “conservative” to have a spiritual life….let’s put an end to the “right/left” notion about gender identity.  I myself have certainly never felt pinned down by gender stereotypes.


 Gary (New London, MN) says:

Early in the spring of 2015, a number of NL-S school district residents met with the school board to express concerns about their proposed transgender policy. This controversial policy was presented without any advance notice to parents or the community.  We were stunned that the Board of Education and the administration chose to ignore our request to delay its adoption.  Very few have had the opportunity to become aware of the policy, or to read and understand its implications. A simple delay is a most reasonable request. Why the rush?

Are we in this community ready for a policy that allows boys to use the girls’ locker rooms and girls’ bathrooms and to participate on the girls’ athletic teams? That will be the almost certain result if the school board’s proposed transgender policy is adopted.

The proposed policy states that the school is committed to “maximizing the social integration” of transgender students. This means that boys who at any time wish to see themselves as girls can do anything in schools that the girls do. These boys can use any of the girls’ facilities and participate on any of the girls’ sports teams.

We weren’t misled by the superintendent’s statement that it may be that transgender students could use “gender neutral” bathrooms and showers. Other schools tried that approach only to find themselves sued by GLTB lawyers and then forced to open all girls’ facilities to the boys.   “Maximizing the social integration” for transgender students does not allow for keeping the boys’ and girls’ bathrooms and showers separate.

Our Board’s proposed policy says that “sex is assigned at birth.” What kind of fantasy is that? My own experience is hearing the doctor or nurse say, “It’s a boy!” or “It’s a girl!” I have yet to hear the doctor ask, “Which sex shall we assign this to baby?”

Aren’t schools supposed to teach our kids about the real world? This new policy requires our schools and teachers, by word, example and policy, to substitute a fantasy world for the real world and force our kids to conform to a make-believe world where biology isn’t real.

And what about the nonsense that putting our kids into a fantasy world will supposedly lower suicide rates? There is no evidence that such is the case. But, when we enter fantasy land, there are no limits to where it takes us, because truth and reality no longer matters.

We need to provide safety to all children, and many see this policy, as written, as harmful to every child. Keep in mind that most gender-confused children lose their confusion by the time they reach their 20’s. We all want all children to feel loved and accepted. Are we really helping them by affirming their confusion, rather than helping them address the underlying issues causing it?

After much deliberation and many revisions to the policy, the school board refused to remove the most objectionable wording that was contained in the policy; that being:  No one will be denied access to opposite-sex bathrooms or shower rooms.

We formed a community group in order to better equip us to oppose the ‘Gender Inclusion Policy’ (as they later labeled it), and with the help of numerous parents and concerned citizens did convince the school board to table the proposed policy until further guidance has been initiated either by the courts or other educational entities.


Miriam says:

Last February, a 15-year-old boy who claims to be a girl walked into the girls’ locker room at the school my child attends and began to undress in front of them. The girls, who were changing for basketball practice, some without shirts or shorts, were shocked and upset by the boy’s presence, so they ran out of the locker room wearing towels to a bathroom to finish changing. The boy tried to use the girls’ locker room again two days later, but was prevented by one of the girls’ boyfriends, who stood in his way. The girls in the locker room were devastated; they hadn’t been warned that boys would be allowed to use the girls’ locker room.

I got together with a few other mothers and we called the police to notify them of ongoing indecent exposure at the school. Then and only then did the school write an email to a few of the parents to inform them that there was a transgender girl (biological boy) using the girls’ bathrooms and locker rooms. The letter looked almost identical to the one that the Palatine school district used to notify families of bathroom use regulations. Additionally, the school told parents that we did not have a choice in the matter. They said we could home school our children if we didn’t like it.

The school then hosted a LGBT information night for parents and a day training session for students and teachers. The gender training facilitator used the “Gender Unicorn” as a visual aid for the students. The concerns of parents about mixed bathrooms were dismissed and there was no interest in finding a compromise. We discovered that our school had been hiding the fact that there was a boy in the girls’ room for over a year. They never said a word until the police got involved. Also, we were told that the district is “required by law to allow the boy to use the girls’ bathroom and locker rooms.” The same boy, who has been allowed to be a member of the girls’ basketball team and the girls’ marching band, has also demanded to sleep in the same hotel rooms with girls on band trips, but he has so far been denied.

A district elementary teacher reported that she was told by the administration that she was required to allow her students to use opposite-sex restrooms if they “identified” as the other sex. A female elementary student was even told to use the boys’ bathroom, simply “because she likes to do ‘boy’ things” and prefers pants to dresses. They claimed the law required telling her that.

genderunicorn1

Don’t believe the rhetoric about gender identity laws simply allowing someone to pee in peace; it’s not just about the bathrooms!

I would encourage parents everywhere to go to school board meetings. Be proactive and ask your athletic director to make sure your children have access to an alternate changing, showering, and restroom area.


ThinkingMom says:

Emily’s story has struck a real nerve with me.  My children have been attending a school very similar to the one that Emily’s kids attended, in another state.  It has been a great school and was founded on classical teaching.  My older child started having issues with what we are now learning is a borderline personality disorder, and possibly autism spectrum disorder.  She struggled with the large amount of homework at that school so we moved her to an associated charter school.  There, she was friendly with several kids who were identifying as “gender non-conforming.”  They started doing lots of cosplay, and copious Internet use – YouTube, Reddit, Tumblr, DeviantArt.  Suddenly, my daughter started dressing differently, cutting her hair short, and even started some drug use.

Now in public school, she started going by a male name and male pronouns.  The public school, of course, has the policy to accept whatever kids present as, without parent consent or knowledge.  Each of the teachers and counselors I have dealt with are very apologetic about not being able to respect the parents by using given names, but have apparently received a directive to “make the student feel accepted and comfortable.”

The longer my daughter has gone by male pronouns and a male name, the more anxious, depressed, and rebellious she has become.  At home, she generally acts the way she has always acted, no pretense of male persona, no voice altering.  But she becomes irate when we don’t use her preferred name and pronouns because after all, “HE is accepted and admired at school by friends for being so unique”– we just are ignorant and don’t see who HE really is.

I will tell you who SHE is: She is still the sensitive, creative, intelligent girl who loves to take walks in nature and collect wildflower bouquets and unique rocks and bugs.  She still gets compliments on her beautiful singing voice, on her beauty, and her kindness.  But now, with all the “support,” she cusses like a sailor, sits with her legs wide apart and talks loud and abrasively, rude and crude, when in public.

The schools are just making things worse by making this a part of the education system.  It is something that should be dealt with by professionals, therapists, counselors–and by the families.  It makes things so much worse with the open and blatant pandering to the activists.  These kids are suffering and the help they need is NOT to become the poster child for their school, or their community.  The pressure to continue on the path of transition is now so intense, just because everyone is now watching.

What it is becoming is another platform for activists who use children as pawns for their activism.  It keeps the real problems – mental health issues – hidden and undiagnosed.  Self acceptance is so important for every human being.  Why has it become such a taboo subject and so many are working against it for the sake of permanent damage – hormones, medication, surgery – that will not even touch the real issues?

I do agree with one thing: School should be a safe place for all kids.  ALL KIDS. 
So why are the rest of the kids, the ones who aren’t suffering from these mental health and identity issues, being pushed aside?  Their feelings about themselves, the world, their friends and life in general, are being squashed and treated as unimportant compared to the few kids whose parents are intent on pushing the agenda on everyone, maybe for their own 15 minutes of fame and attention?  I am not saying it’s the parents’ fault in every situation, since every one of these situations also have a lot of other professional adults involved.  I just see this as such a tragedy for everyone involved.  We need to stop it now.  With this new school year, I see the problem getting worse, much worse, before it ever gets better.  But it has to get better, for the sake of our kids and the future for all.


Jane says:

I took this photo over the summer. This appeared on the main bulletin board in a progressive private school that goes from grades 7 through 12. Tuition at this school runs about $30k per year. Most upsetting thing to me about this poster is that “female” has nothing to do with biology: “Female: identifies as a girl. Does not necessarily refer to genitalia.” Might as well teach creationism.

School poster

This is not the only progressive private school in the area to have swallowed trans ideology.


UKMum says:

This is happening in UK schools too. My daughter is one of seven other trans-identifying girls who live within a square mile of us that I know of (clearly social contagion).

One day, she and another trans student knocked on the door of the school counsellor’s office, and requested to be known by boys’ names and pronouns. She told them that we, her parents, were ‘not supportive’ and it was therefore kept secret from us. She was given a new ID badge, all the school records were changed and she was helpfully advised right there and then that she would have to change her name legally by deed poll if she wanted to write her new name on her exam scripts. (So of course, that is what she eventually did!)

The first I knew of this was when the school ‘slipped up’ and sent me a text communication with her boy’s name on. I was driving, pulled over to read the text, and then spent half an hour crying in a layby, until I felt stable enough to continue driving. What a shock!

I wrote to the school, telling them that we were considering having her assessed for Aspergers, pleading that this affirmation by adults in authority would not help at this stage, that this had come out of the blue, etc. I felt it was wrong that she wasn’t interviewed individually by the counsellor and that two kids going together on the same day to request the same thing, should have raised alarm bells about ‘influences.’ Also, as she was wearing a new ID card, with a male name, if she was involved in an accident, she could potentially receive the wrong treatment, since her emergency contacts (us and her grandparents) do not use that name, nor would hospitals be able to access her medical records. (How would they find them, since they are not in this new name?) I felt this was a duty-of-care issue, and the school relented and told her she would have to just use the first initial of her birth name on her card, whilst it was still her legal name.

Of course, within weeks of being known as male at school, she developed dysphoria and felt that she now could no longer go out without a chest binder. Next, she began to be dysphoric about her voice and to intentionally lower it…then a new way of sitting, and beginning to be aggressive and swearing a lot. All of this was completely out of character. Our family and friends have looked on aghast at the rapid decline of our sweet, sensitive, funny, overthinker. It is a nightmare.

Our scepticism has caused great damage to our relationship which has all but broken down, with both sides feeling hurt and disrespected.

During part of the time we were going through all this, our daughter attended a girls’ school. While one might think single-sex schools would be immune to some of this, the official GSA in the UK has now begun the process of replacing the word ‘girls’ with ‘pupils’ so as not to misgender anyone.

Now I don’t want my daughter to go to University because I am afraid that she will be encouraged further down the road. And as she is now an adult, we will just have to stand by and watch her disappear.


Skepticalmom says:

Well-meaning adults need to understand just what they are encouraging kids to do when they give blanket acceptance to all things trans.  Well-meaning school administrators and parents just don’t realize what sort of damage they are doing to kids when they apply transgender ideology within their schools. Although trans is associated with gay rights and acceptance, trans is a much different animal. Of course we want to be accepting of all children, but should we accept, without question, children’s fantasies and false beliefs? While compassion is admirable and necessary, it is not an act of compassion when adults lead children to believe they are or can become the opposite sex.

We are allowing young people to be drugged and even surgically altered, based upon their personal, self-identified beliefs — which have no basis in science. Not only is trans ideology based upon belief rather than scientific fact, the end result is kids who are tethered to the medical system, receiving ongoing medical treatment, for the rest of their lives. School are accepting this and encouraging it. They should be teaching science instead.

Well-meaning adults also may not know that most kids who say they are trans grow out of it if left alone (in other words, no social or medical transitioning) to mature into adults. Well-meaning adults may also not know that many kids who claim to be trans have pre-existing problems such as past sexual abuse or physical or mental trauma, or have mental health issues such as depression and anxiety. There is also a correlation between autism spectrum disorder and kids who claim to be transgender. These issues need to be carefully, thoughtfully and thoroughly explored and sorted out by professionals. Unfortunately, however, current medical protocol allows kids to be socially transitioned immediately upon self identification and begin medical transition shortly thereafter.

My own family is quietly and privately struggling to get my teen daughter past her feelings of not wanting to be female. She is making progress with the help of a psychiatrist and a psychotherapist. She says doesn’t want to be a man — it’s just that she doesn’t feel comfortable as a woman. Yes, this is progress. Yet, if well meaning teachers, parents or administrators invite the trans political machine into our school, I can guarantee you all progress would be lost as she would feel encouragement or even pressure to further her male persona.

My child’s school doesn’t know what we are dealing with at home. In order to help other students who might be dealing with the same issue either now or in the future, I would like to warn our school’s administrators and counselors of the dangers and junk science behind transgenderism, and the fact that teen girls, especially, are falling prey to trans social contagion. I would like to help implement a program that teaches both boys and girls about the dangers of todays easy-access internet porn. However, I must wait until my child is out of our school system, as I can’t risk them finding out about her problem and encouraging it.

Families should be allowed to deal with these situations privately, allowing their therapists, psychiatrists and physicians to do what is right for each individual patient. It is harmful to our kids when schools encourage them to believe they are something they can never be (the opposite sex), or encourage our kids down the path toward dangerous, invasive, unnecessary and never ending medical “treatments.”


TheMom says:

My daughter goes to a very large public high school. As she has not come out publicly, she has not experienced any issues. I do know that her school last year was looking at changing bathroom and locker room policies in anticipation of accommodating trans students. They had one openly trans student a few years ago (FtM), and that student used the bathroom in the nurse’s office, which the student did not find acceptable. But the student graduated and moved on. The school board said that they have a dilemma because their current policy doesn’t allow students to use individual locking bathrooms. Students could go in there and commit suicide, do drugs, have sex, etc. and it would be very difficult for security to get in the bathroom. So they were looking at options. They already have changed their PE policy, stating that students are not required to wear a PE uniform, and that students don’t even have to change for PE if they don’t want to.