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 struggle with gender issues. 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 rapid onset gender dysphoria (ROGD).

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 gender-critical therapists in unlikely places.

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 rapid-onset teen.

As her time permits, Sasha is available to interact in the comments section of this interview post.


Tell us something 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 struggling with 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 only 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. Around 2012 I began more deeply investigating this idea of gender identity purely 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 socialization and gender-norms may play a role in the idea of the “wrong body.” I also questioned 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).

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 any opportunity for deep psychological exploration or self-knowledge. 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 interact and build up the idea 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, it became obvious that something tremendously important and peculiar was happening.

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 fantastic resources.

Sasha photoThen 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 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 educate her about the wider phenomenon and some of the less obvious problems with the 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 ideology advocates. I believe gender ideology proponents 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 I think 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 this belief system, with no real openness to other ways of looking at gender dysphoria. Further, some of these organizations promote this one-sided view unquestioningly to their mental health staff and the children they claim to serve. I also realized there is a scarcity of therapists working with these children in a manner that is not unconditionally affirmative. Other therapists seemed to avoid or block any type of gender and sexuality exploration, which is also harmful 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 during extracurricular activities during my three years at the school.

She stood out from her peers 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 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 cycled through 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 being sucked up into this vortex of confusion. The kids I meet in private practice are first introduced to me in the midst of their gender struggle, 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 is very unsettling. 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 problems are and how to solve them. That will require me to be really honest about what I see and for you to be really honest too, and sometimes counseling can be hard for those reasons. We also work together to really face your pain and see if it has something important to teach you about yourself. We can also look for ways to loosen the grip that pain has over your life so that you can find more confidence and purpose.”

As for the specifics, my approach is highly tailored to the constitution, mindset, resilience, age, and maturity of each client. I always start with trust and initial bonding, which can be hard with some clients who understand gender affirmation as a prerequisite to feelings of trust and safety. With more open clients, who are less defensive and more conversationally or intellectually predisposed, we might discuss the 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. I draw from Acceptance and Commitment 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. Speaking with teens often gives me insights into ways that parents can deepen their relationship with their teen and to 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.

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?

Interestingly, I have not received too much negative pushback, but I don’t believe it will stay that way for long. I’ve seen a few people on Twitter make false claims about me, and some trolls have left unsavory comments on my blog posts. But these instances have not impacted my practice or my clients, as far as I can tell. When I speak with people about my practice face-to-face, I am typically met with far more inquiry and curiosity than hateful responses. Online though, people seem to respond with a great deal of assumptions, accelerated vitriol, and regurgitated one-liners from the trans advocacy playbook. There’s a huge difference between how my work is viewed online by trolls and in person by real people.

That being said, I have been blocked on social media by a few real-life acquaintances, which was eye opening for me. These people know nothing about the “trans kids” phenomenon, but they are the types who automatically adopt what they perceive as the correct liberal position and jump on the bandwagon without really thinking deeply about the issue at hand. Being treated this way by others on the left of the political spectrum has helped me to question many of my own long-held beliefs. I’ve wondered, “if people like me could be so blindly wrong about this, what have I been blindly wrong about?” It’s been one of the most intellectually stimulating and freeing experiences of my life to actually question my own deeply-held ideas with this much curiosity and openness.

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, but let me rephrase these questions a bit and answer them for kids.

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

If by “risk” we mean body discomfort or feelings of incongruence, then trying to prevent that risk is the wrong aim to strive for. Discomfort and biological limitations are ubiquitous and necessary teaching tools that have been a part of human existence throughout history, and felt particularly acutely in adolescence. The struggle between budding aspects of femininity and masculinity, 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.

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 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 girl 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.

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. 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 transgender-affirmation advocates is incredibly manipulative and has no precedent whatsoever in the field of psychology. 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 plans with the child and their family, and work through underlying issues if we really care about their 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.” However, we have all taken vows of high ethical standards and going along with the affirmative approach undermines our professional moral duties.

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 transitioning children appear, there’s often a dangerously aggressive and thoughtless effort to dismiss and diminish such 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 good always involves a risk and personal responsibility, a burden which I feel deeply committed to shoulder.

I strongly encourage other clinicians to speak the truth and be honest about what they are seeing, because complicit silence only makes more room for absurdity and confusion.

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

Individuals listening to their gut, questioning actively, educating themselves, and finally, acting with honesty and courage. Because when I talk with people one-on-one, there’s a deep intrinsic knowing that we have spiraled out of control when it comes to transitioning kids, but people are afraid to even think deeply about it, question anything, 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.

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 ideologies, 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. 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. In general, the more you can keep them offline, engaged in 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 garbage. Set their bed-times, take their phones away overnight, and make sure they eat regularly and get plenty of physical exercise and real-life play and social interaction.
  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? 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, 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. 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; this is why reducing the time your kids are on the Internet is so important. In my clinical experience, most rapid-onset dysphoric kids didn’t feel any gender incongruence until they learned what it was from social media sites. That being said, take the time to really listen to the gripes they have with the “girl role.” They likely have some very poignant observations and ideas to share.
  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 ubiquitous 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 why you don’t agree with their thinking. They need to hear the truth, because they aren’t going to hear it from friends or the internet.
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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 Jontry

Brie is public spokesperson for 4thWaveNow. For more about her, see this interview. For more about Brie’s formerly trans-identified daughter, Maxine, see here.


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

Maxine [a pseudonym] is the 14-year-old daughter of Brie Jontry, spokesperson for 4thwavenow (see here for more from Brie).

Maxine believed she was male for 2.5 years, from age 11-13, but has changed her mind. In a Skype interview (transcribed below), we asked Maxine to tell us about her journey towards a trans identity, and how she came back home to herself as female.

Maxine, along with her mom Brie, are available to interact in the comments section of this post, as their time allows.

All artwork in this post is by Maxine.


For a couple of years, you thought you were transgender. How did it start? Why did you think that?

It started when I was 11. I thought I might be trans after spending time online where I saw people saying that if you feel dysphoric, you must be a different gender. So many people were saying it, that I came to believe it. At first, I identified as agender and then after thinking about it more, I realized I was a boy because I wanted to be “masculine.”

What did that mean, be “masculine?”

 For me, it meant wanting the physical characteristics of adult males: a beard, being taller and strong. And being masculine was about feeling safe.

Were you dysphoric?

I felt like I didn’t want to be in my body. I didn’t like it. It kinda felt like my body wasn’t mine and I wanted a different one.

What was going on that made you feel like that? What was it about your body that “wasn’t yours?”

A few different things. Mostly, it was previous trauma and being in the early stages of puberty. I don’t know anyone who isn’t uncomfortable during puberty, but at the time, I thought the way I was feeling was something extreme and different.

I used being trans to try and escape being scared about being small and weak. I thought that if I presented myself as a man I’d be safer.

What first got you thinking about being trans?

Things online. First, it was on DeviantArt. It’s an art-sharing website, but the DA communities I was in, which were made up of kids drawing animals and other original characters, went from sharing and commenting on each other’s art to being super dramatic and depressed. It also turned into a disrespectful “call-out” culture.

noor color cat

Some of the people I was watching, whose art I admired, came out as trans. Some people posted about how much they hated themselves and how badly they wanted to transition. Some started to transition and talked about how amazing they felt. Suddenly, a lot of the people I knew on DA were making transgender artwork.

Why do they call it “DeviantArt”?

There are some “deviant” areas of DA but the places I spent time in were for kids sharing art but I don’t think it is the main focus anymore. It was originally a great art site and I made a lot of friends there and everyone was very nice to me. I liked it. It was a friendly art community.

But now it’s mean. And it’s also a place for kids to post about all their self-diagnoses and identity issues. I know lots of kids who post about their self-diagnosed schizophrenia and other mental illnesses.

All these self-definitions, are they real?

I think the kids believe they’re real. But I don’t. If someone calls themselves “schizophrenic,” I believe they believe they have it! But it isn’t a disorder a teen can self-diagnose.

Were there other online places besides DeviantArt that influenced you?

I started to use Tumblr, also because of the art. Reading people’s bios, I learned more about being trans and that what I was feeling is called “dysphoria.” There are a lot of artists there expressing their dysphoria in comics and I identified with some of the things they were saying

From Tumblr, I found YouTube transition videos. When my dysphoria got worse, I started watching a bunch of FTM videos. All of the ones I watched were like, “I feel amazing!” and “I am finally my true self!” I thought it was weird that no one regretted anything but I wanted to believe medical transition would help me too. I started wanting hormones and maybe even surgery later.

I also talked to some of my friends. I was in a homeschool group and lots of the kids there were also trans.

“Lots” of the kids were trans? How can that be, when trans make up a miniscule proportion of the population?

 I wonder how accurate the data is that tells us only a “miniscule proportion of the population” is trans, because most teens I know identify as anything other than “cis.”

Hollow wolfIn my homeschool group, there were only two girls who didn’t have trans identities. Talking about gender identity and sexuality was very popular with my friends and also some of the parents. There was a parent who identified as pansexual and “demi gender” or something like that. She came and talked to all of us about using preferred pronouns and sexuality stuff. She was a facilitator there but not for my group. It was just a bad time even though I had a few really good friends there. There were some kids who were always talking about how oppressed they were and they weren’t. At all. They thought disability and mental illness were cool. They’re not. It was hard for me to hear them talk about all their self-diagnosed issues when I had to give myself insulin every day (I’m diabetic) and I hated my body. Also, my grandfather had just died. My mom started not wanting me to go there because I would get really anxious and have panic attacks and she would come pick me up early.

 Trans activists and some gender therapists insist that some people are “born in the wrong body” and that causes terrible dysphoria. They claim this is very different from not just conforming to gender stereotypes (even though many published accounts of dysphoric people also include stereotypes). Is dysphoria real?

It is definitely a real feeling! But being uncomfortable is part of being human. If you can’t cope with those feelings, then you need help learning better ways to cope. My psychologist understood I had dysphoria and we worked through the trauma that caused it.

Feelings are feelings. Feeling something doesn’t mean it is true or real. I didn’t understand that at first.

noor catAnd I thought that I would feel better as a boy. I wanted to stop my natal puberty because I didn’t want to be female. I thought taking testosterone would make me male. But now, I don’t think it’s healthy to be hurting yourself with hormones. Taking T is a very harmful thing to do to your body. There are YouTube channels where they’re talking about how great T is. But I wonder what they’re going to say in a few years? I wonder what’s going to happen to their bodies? If they say it’s totally safe, they’re wrong. I wanted to medically transition, so I looked up a lot about it. All I found was, “oh this is safe for you, you’re gonna feel better.” But then I found some other articles, that talked about heart disease; things like needing a complete hysterectomy in 5 years if you’re on testosterone because of what it does to your uterus and ovaries. My mom found other things for me to read. But you know what? At first, I didn’t want to believe that it was dangerous. I even thought I could block puberty forever and when my mom said that wasn’t true, I argued with her.

I talked to our friend who is a scientist and she told me more things about blockers and my brain development. I trusted her and I trusted my mom so I knew they were telling the truth but I didn’t want to believe them.

In my homeschool program, I tried to talk to my friends about this stuff but they said it was transphobic and I was wrong.

Do you think there are some young people for whom transition is a good choice ?

I know one person who’s on testosterone, and I believe transition is the only way for him to be happy. At the same time he’s very aware of how it’s going to hurt him.  I think he’s very young to transition, even though he’s 19, it’s very young. But he believes something bad will happen to him without testosterone.

Some people may need to transition but it should always be a last resort.

How is your dysphoria different? Why is medical transition not appropriate for you?

Extreme dysphoria might mean you can’t get out of bed in the morning or function at all.  But thinking about it in a more critical way, what teen doesn’t experience being uncomfortable about their bodies? Dysphoria is just an extreme version of that discomfort.

It was that bad for me for a while, and sometimes it can still be bad, but I’ve learned to move my body when I feel that way and do other things that don’t feed the feeling.

What kind of things do you do to work with your dysphoria?

I draw. I pet my animals and play with my Madagascar hissing cockroaches. I don’t lay in bed doing things that make me feel worse.

I used to watch FTM transition videos when I felt dysphoric. They made me feel even worse and also jealous and anxious that I might not transition soon enough and that I would never be masculine enough.

I know this sounds cliché but you have to find something to love about yourself instead. For someone like me, who thought I was FTM, think about the ways you’re already “masculine.”

Discomfort about your body and sometimes dysphoria are a normal part of being a teenager and having your body change.

I know some people who feel so wrong that they want to mutilate their bodies. That was me for a little while but it isn’t me now. Even when I was wearing a binder, I thought I looked physically better but I still hated my body.

So the image you presented to the world was “better” but it didn’t make you feel any better?

I remember being 11 and it was the beginning of summer. I was downtown with friends and their parents and one of the men made a joke about the way another little girl was dressed in short-shorts and a tank top. He said something like “I’ll never let you dress that way” to his daughter even though her brother was already dressed just like that! Then, a little bit later in the day, when a woman walked by he said “I love booby season.” That’s the kind of thing that made my dysphoria worse and made me sure that I would be happier as a boy.

noor muralIt made me think of myself a little better when I was wearing a binder but it wasn’t a good solution because it was physically hurting me. They’re not comfortable. I didn’t care then that it hurt to wear it and it didn’t really help wearing it, because I knew I still had boobs. My ribs still hurt and sometimes it is still hard to breathe even though I haven’t worn a binder in over a year.

The kids I know who are trans brag when they’re having a hard time breathing. They act like it is a cute little “trans-relatable” experience when they feel like passing out from wearing their binders for too long.

What made you change your mind?

 I realized that the only reason I was trans was because I wanted to feel big and safe and also, I didn’t conform to what I thought being female looked and felt like. But then I learned that being female isn’t a feeling. It’s a biological reality and I could feel however I feel without it meaning I was male.

Also, I have type 1 diabetes. On my five-year anniversary of going into the hospital to be diagnosed, a friend who was on testosterone injections texted me to complain about her monthly shot (she has detransitioned and uses female pronouns now). When I read her text, I felt anger, but I knew she wasn’t trying to hurt me or be mean. But I was so jealous. She didn’t have to get shots. Why would anyone want to be dependent on medication if not absolutely necessary for a serious medical condition? I saw everything clearly. I changed my mind at that moment. I would never transition medically.

At first, even though I knew there could be side effects with blockers and testosterone, I was okay with going ahead with that. Because if I hurt my body, I was in control of that. When I identified as trans, there was always a way I was hurting myself: wearing a binder, pinching myself, picking at my skin, cutting.

But why should I hurt my body to feel control over things around me that are messed up?

I remember driving to one of my homeschool programs and I was telling my mom that I wanted to transition because I would feel safer. And my mom said something about me turning my back on other women. I also realized that I was wrong thinking transitioning would make me safer. It wouldn’t. And I’d also always be afraid of not passing.

Your mom told us she took you to the Philly Trans Health Conference so you could learn more about trans issues—you even had a pizza party with Jazz Jennings. It sure sounds like your mom was open-minded about all of this.

My mom was always very open minded. She never pushed anything on me or tried to push any ideas away from me, unless it was something dangerous, like crossing the street without looking.

One of our friends posted my mom’s interview on Facebook and one of the comments was “this mom is pushing things on her kid.”  It was never like that at all. My mom wanted me to explore the thoughts I was having. She just didn’t want me to medically transition but even then she was being supportive. She never flat out said “no,” she just said that I needed to think about it and research it.

Do you think if she had been more resistant, if she’d said, “no way we’re going to that conference” or “no way you’re a boy” do you think that may have made you want to do it more?

I definitely think that. You know, as a “stubborn teenager” I would have wanted it more.

What was it like going to that trans conference? Did you feel connected to the other kids there?

All the kids were really friendly. But I did feel some pressure after talking to kids there to “look more masculine.” It was interesting. It wasn’t a bad experience.  But most of them were like Tumblr-SJW trans; I definitely got that vibe from them. When I was identifying as trans, I was what they call “truscum” or “trans-medicalist:” you have to have chronic dysphoria to be trans, and you definitely want to get some kind of help for that problem—not necessarily hormones, but maybe talk therapy if you just want to learn to cope with your dysphoria.

Philly trans health banner 2015

None of those kids were trans-medicalists like I was. I hate saying the word “snowflakes” because it seems rude, but…There was stuff like, “you can’t be a trans boy unless you get your head shaved and dyed.”  It’s like the trans-boy starter pack. They all had the same haircut. I don’t remember if anyone said exactly “you need to cut your hair and take hormones” but I felt that vibe from the other kids who were all talking about their anxiety over passing and being more “masculine.” I wasn’t wearing a binder yet but I was sure I was trans. I had long hair and I loved my hair so I didn’t cut it. Even then, I thought it was silly that all the transboys I knew had the same haircut, shaved on the side and dyed blue or green or some blue streaks, and that they thought boys had to have short hair.

That sort of made me question. I mean, all these kids were following the same exact trend. I never wanted to brag about being trans. Stuff like pronouns was the least of my concerns; I just wanted to deal with my dysphoria.  Because that’s a mental feeling, something people can legitimately feel.

In the banquet hall where they had a pizza party for trans kids and their parents, a few of the moms had their kids pull up their shirts to show off how great their binders worked to flatten their breasts. My mom remembers that a few transboys also showed off their bare chests and people talked about what a good job their surgeons had done. Some of them were like 14 or 15.

So did that event push you more or less in the direction of thinking you were trans?

It pushed me toward wanting to medically transition, but I saw what those kids were doing as trendy. Like, there was a whole line of penis packers there, in different colors and sizes. There was a neon pink one hanging up on the wall. It was horrifying. There were some for 6 year olds. Six year olds shouldn’t be worrying about what’s in their pants unless there’s a problem going on. I think it would make little kids sad to think about having to fake it.

Did you want one?

God, no. During that time I did want a penis, but not a fake one.

So you eventually wanted surgery?

No, I didn’t want bottom surgery. I just wanted to be a biological male.

So the gender therapists and activists might be saying right about now, ok. This kid figured out she wasn’t really trans. No harm done. Mom and dad, chill. Use their pronouns. Take them to a trans conference or a gender therapist. No harm done.

I think if I had gone to a gender therapist, I would still think I was trans now. If my mom had thought that hormones and blockers were the best solution for my anxiety and dysphoria, I would be taking T right now.

I’m glad she didn’t believe I was a boy trapped in a girl’s body. I’m glad she found a psychologist who saw how scared and angry and hurt I was and who wanted to help me with those things first instead of also helping me transition to be a boy.

But parents should be supportive and respectful of their kids. They should take them seriously and learn about side effects of transition and alternative opinions about gender together. Let them break stereotypes and talk about those stereotypes and where they come from and how they hurt people, not just girls, boys too. And kids need good therapists who will ask them questions they never thought of.

Until quite recently, believing oneself to be the opposite sex was considered a mental disorder and treated as such.

It is a mental disorder sometimes. People who feel mild dysphoria are like “I hate this thing about my body” which is different than “I hate this thing about myself and I am willing to hurt myself to relieve the feeling.” The second is a mental disorder. Somebody wanting to hurt themselves is a mental disorder. Dysphoria always has a deeper root.

“Trans” isn’t the right word. We’ve learned to know it as trans but really what I think some people feel is extreme, chronic dissociation, possibly from trauma and PTSD.

And for adults, it is different. Adults can do whatever they want, even if they don’t have dysphoria or other mental health issues. But kids need their parents and sometimes a psychologist to help them think about why they feel the way they do.

I don’t know any trans kids who have gender-critical therapists. And by the way, being gender critical wasn’t pushed on me either, but my mom and my therapist and other friends would gently suggest that I think about things beyond just “being trans.” They’d say I should think about why I felt that way, the reasons for feeling that way, and any other perspectives or reasons someone might feel that way. And that I should also think about my history and my experiences and relationships and why I might feel uncomfortable or not want to be a girl.

Parents who put their kids on hormones are trying to take care of their kids. I know they want to do the best thing. But what if they haven’t heard other ideas and they don’t understand about being gender critical, or about how to see their kids’ identity or presentation without stereotypes?

Most parents just want their kids to be happy, and their kids say “I need hormones to be happy.” Some kids even threaten to kill themselves if they don’t get the treatments they want. I’ve also seen kids say that after they started cutting, their parents took them seriously, and let them take hormones. There are places online that tell you, “This is how you come out to your parents to get hormone therapy.” I always hated those, because it was always … just threaten something to get what you want. That’s just putting so much pressure on your parent to make an impulsive decision and it’s such a terrible thing to say. I know people who’ve killed themselves and also people who have tried to kill themselves. People who are suicidal need help and love but using suicide as a threat is manipulative and cruel.

 Did you see a lot of that online?

 Oh, everywhere. Everywhere. Most ways to come out were like, “say this, you’ll be sure to get them to take you seriously.”

We see this in every news article—“Would you rather have a live daughter or a dead son?” It’s why most parents decide to agree to medical transition. It’s the worst thing that could happen to a parent. It sounds like people are being coached to say they’re suicidal, when they aren’t?

 I think being truly suicidal is rare. Like the true trans thing.  Some trans identified people I’ve known will threaten to cut or hurt or even kill themselves when they would never do any of those things. For the few that are serious, it ties into mental illness: If you are going to kill yourself because of gender roles, or stereotypes, or even dysphoria, that’s a mental illness. And it can’t just be fixed with a bunch of medication. Some of the accounts of boys trying to cut their penises off in the bathtub—that’s clearly a sign of mental illness.

You’re 14. Pretty young still. How do you know you’re not going to change your mind again or want to go on testosterone?

I’ve read a few comments on Facebook about my mom’s interview. One was really insulting because it said that I’m too young to know what I want and that my mom is manipulating me.

But if I had said I am trans, I’m sure that person would believe me and not worry that my mom influenced me. So, can’t I also know that I’m not trans?

How can any thirteen-year-old or their mom know that they’re “really trans” either? That’s why you shouldn’t make any permanent changes to your body at such a young age. I don’t know anyone my age who hasn’t felt uncomfortable about their bodies at some point. Everyone I know wishes there was something different about their bodies.

If it is on your mind 24/7 and you feed that idea, you give that idea power – and you start to feel like you need to do something to your body to feel better.

The idea of gender is harmful. It encourages dysphoria. It locks people into stereotypes.

Some people say that you shouldn’t help kids feel comfortable about their bodies or even feel okay with being a little uncomfortable. They say that’s “conversion therapy” to talk someone out of wanting to hurt themselves. It isn’t conversion therapy to learn to love yourself or at least, feel like you can live in your own body without hurting it on purpose.

That was Dr. Ken Zucker’s goal: to help younger children, especially prepubescent children, come to feel peace about themselves and in their own bodies. He says that in childhood, gender identity is subject to change, and if you can help a child not become a permanent medical patient, that’s a good thing.  It was controversial, but in at least some cases, he discouraged “gender nonconforming” behavior in young kids—things like toys, haircuts, and clothes more typical of the opposite sex. What’s your opinion on that?

 Toys and clothes don’t have genders. Kids should get to play with whatever they want and wear whatever they want. Kids should be allowed to explore the things that they find interesting. When I was little, I didn’t see clothing or toys as gendered. Parents need to keep gender ideas like that away from their kids. “Female” isn’t a way of dressing.

I was shopping with my mom when I was little, before I thought I was trans, and we were in the “boys” part of the store because I liked those clothes better. They’re more comfortable and have better pockets. And a salesperson came up to us and asked my mom, “What is your son looking for?”

I wasn’t offended. But it’s silly that she thought because we were looking at comfortable clothing we were shopping for a boy.

And agreeing with a girl that she is really a boy because she doesn’t like to wear dresses might lead to going to a trans support group or seeing a gender therapist and other things that result in a kid thinking they need hormone therapy. If medical transition wasn’t available,  I don’t think it would matter if a girl thinks she’s a boy for a while, because she wouldn’t be encouraged to do things that are harmful.

Parents should give their kids more choices about more things in life but not about things that will harm them.

What would you say to other girls who think they are boys? Any advice for them?

 There’s nothing wrong with your body. To be straightforward, you will never be male. You will never have a Y chromosome. You will never have a real penis. Stop hurting yourself. Not wanting to be female doesn’t mean you’re really male. Not wanting to be female makes sense when girls are sexualized before we’re ready to even feel sexual, and when people think we’re weak both intellectually and physically, when people don’t take us seriously, when people tell us to smile and be nice.

You weren’t born in the wrong body because that’s not possible.

You were born into a society where looks mean everything. But really our bodies are just what keep us alive. Why don’t we fight back against the idea that any person looks wrong as they are? Your “outside” doesn’t need to “match your inside.” The outside isn’t important enough to hurt yourself over.

Get angry at gender stereotypes. You can dress however you want but that’s called “fashion” or presentation. Your identity should be who you are and the things you do, not what you look like. I have resting grouch face. I don’t need to train my face to look kind or have surgery to make my face look kind, I just have to be a kind person.

You think, how can I act male? There’s no such thing as acting male. Male is a biological sex and you will never be that. Just act like you.

Go outside. Move your body. Make art, do something. Don’t spend time with other people’s stories about self-loathing and self-diagnosis. Stop feeling oppressed when you’re probably not oppressed. I know transitioning can make you feel like you get a lot of control but medically transitioning doesn’t give you power. It just makes someone else money.

Find people to talk to and ask for help if you need it. And find people who will ask you hard questions.

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.

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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.