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, Noor, 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.


Brain sex: The jury is still out—but does it matter?

Early this morning, Think Progress (a “progressive” news outlet) posted on Facebook what was meant to be a provocative pull-quote from its latest trans-kid piece by reliable journalist propagandist Zack Ford, “It Takes A Village To Bully A Transgender Kindergartner”:

And what exactly is the “need” of this child? A boy in kindergarten would like to be accepted as “girl”? Well, as a woman, I take offense at any boy who is pretending to share my gender when he quite clearly NEVER can nor ever will. … He is not. He never can be.”

The commenter quoted is, of course, a woman (a bigoted bully, as seen through Ford’s tunnel-vision lens) who questioned the parents’ need to socially transition their 5-year-old child. The child’s transgender status has resulted in a giant kerfuffle as result of the Minnesota school’s dilemma in deciding what to do to accommodate the kindergartner.  Zack Ford paints anyone who questions the wisdom of a 5-year-old boy being assured he is really a girl as an ignorant transphobe, a bigot supported only by right-wing conservative groups.

Zack Ford Facebook
In this post, I’m not going to be writing about the fact that it isn’t just conservatives who question the trans-kid trend (obvious to anyone who reads this blog on a regular basis, or for that matter, the increasing number of blogs by left wing parents, professionals, and feminists. Check out my blogroll). Nor will I be dissecting in detail this “news” article set out as bait on the Think Progress Facebook page to incite the reliable progressive hordes.

Instead, my interest in Ford’s latest bit of Newspeak revolves around the huge number (easily 10-1) of reader comments on that Facebook post, which can be paraphrased as follows:

You stupid bigots! Go read up on the science of gender identity. Gender identity is proven, settled brain science. Little kids KNOW from the time they’re born what sex they are. Plus intersex. No one “chooses” to be transgender, they’re born that way.

 I’ve spent thousands of hours marinating in gender dogma and research studies, both pro- and con-, re: “innate gender identity.” So while it’s no surprise to me to see some people spouting as FACT the totally unproven hypothesis that gender identity is set in stone at birth, what does surprise me is the sheer numbers who have bought what, at best, is a tenuous theory, and who have thereby completely shut down even a modicum of critical thinking.

Of course, who can blame well intentioned progressives? They’re fed bittersweet mouthfuls of Innate Gender Identity gruel every single day not only by the media, but even by the President of the United States, who via his Department of Justice, baldly asserts on line 36 of the complaint against the state of North Carolina:

36. Gender identity is innate and external efforts to change a person’s gender identity can be harmful to a person’s health and well-being.

DOJ complaint

US v. North Carolina

(And it’s not just these few lines. The entire complaint reads like boilerplate trans-activist dogma, and interested readers are urged to take a look at the rest of this document).

This increasingly unchallengeable notion that gender identity, aka “brain sex,” is innate, hard-wired at birth, and thus absolutely unchangeable (despite the efforts of us horrible bigoted parents who are rooting for our kids to commit suicide) means, to the masses who now parrot it like the top graduates of a Maoist Re-Education Camp: Every toddler who claims to be the opposite sex must be agreed with by every adult who comes in contact with the child. Innate gender identity is the ironclad reason why no one is supposed to question the sudden flood of “trans kids” we hear about on a daily basis.

Given the gravity of all this—that little kids are now being ushered aboard a train that will lead inexorably from puberty blockers to cross-sex hormones (with concomitant irreversible changes) in 100% of reported cases–these brain sex/innate gender identity claims can’t just be ignored and dismissed. Not when so many  people—more every day—have swallowed them whole.

Here’s the thing. There is some research that supports a role for biological, genetic, or physiological factors in gender dysphoria. And as much as people on “my side” of this argument (the argument being: should children be “transitioned” to the opposite sex on their own say-so?) would like to simply dismiss any and all evidence for biological aspects of things like gender dysphoria, it’s not that simple.

Shunning entire lines of research because we are made uncomfortable by the findings should not be the way of truth seekers. If opening our minds to their claims changes our position, then so be it. As medical historian and intersex-rights activist Alice Dreger says in her book Galileo’s Middle Finger which chronicles (among other things) the chilling effect of activism on scientific inquiry,

[it is] a rare trait in activists: a belief in evidence even when it challenge[s] our political goals.

Human beings, in general, do not appreciate having their cherished ideas challenged. Political viewpoints tend to be set in stone, with any wavering seen by one’s allies as a dangerous and slippery slope. Evidence contrary to the ideological convictions of either side is taken as an existential threat to the fundamental integrity of the position.

For instance, people (like me) who support a woman’s right to abortion often avoid  acknowledging the fact that a fetus is not just an amorphous mass of cells, but a proto-human being. Conversely, anti-abortion advocates give short shrift to arguments about a pregnant woman’s agency over her body, and the critical importance of a baby coming into the world to a parent who is ready–and can financially afford–to raise the child.

The battle lines dividing those who support the idea that self/parent/activist-identified “trans” kids should be transitioned as young as possible, vs. those who disagree (like me) are drawn across a long-contested and hardened piece of ground: nature vs. nurture. And the opposing combatants are highly reluctant to give even an inch on the matter.

As you’ll see, this post is going to argue not for a détente or concession of territory, but rather, for a willingness of “my side”—the gender critics–to consider the evidence marshaled by our detractors, and then ponder whether it changes your mind. I’m only going to touch on a few areas of research typically used by the trans activist side; if you’re interested, you’ll want to spend some delving time yourself.

Let me cut to the punchline right now: Speaking for myself, weighing the claims (and the research they base it on) of the activists who want to transition children as early as possible has actually strengthened my conviction that medical transition should be an adults-only decision, if made at all. The only thing I can say I might have shifted my opinion on after endless investigation is this: There may be a very small (it’s always been very small) number of people for whom medical intervention is the only way they can live a happy life. I don’t believe we should prohibit these interventions for such people as adults. I still do not believe, weighing up all the evidence, that we should be tampering with the bodies of young people who may very well grow up to be happy without the expensive, drastic, and irreversible meddling of the gender-soaked medical and psychiatric professions. Instead, as I harp on constantly, let’s celebrate and support gender defiance in young people.

So let’s start with the obvious. [Note to regular readers: The information in the next couple of paragraphs is well known to you, but please stick with me, because I’m going to cover some research I haven’t formerly written about]. If gender identity is “innate” how come so many gender dysphoric youngsters change their minds?

4thWaveNow is chock-a-block with posts and research studies—as well as personal narratives from formerly trans-identified people who changed their minds, as well as others who experienced and resolved severe gender dysphoria in childhood—supporting the fact that many children outgrow their dysphoria and grow up to be adults happy to have bodies and brains that have not been tampered with by the medical and psychiatric professions. A 2008 meta-study by Korte et al sums it up:

Multiple longitudinal studies provide evidence that gender-atypical behavior in childhood often leads to a homosexual orientation in adulthood, but only in 2.5% to 20% of cases to a persistent gender identity disorder. Even among children who manifest a major degree of discomfort with their own sex, including an aversion to their own genitalia (GID in the strict sense), only a minority go on to an irreversible development of transsexualism.

Because so many trans activists claim that intensity of discomfort with one’s body parts is some irrefutable sign of “true transgender,” or that prior researchers didn’t adequately differentiate between “true trans kids” and the merely “gender nonconforming,” I’m going to emphasize this bit of the above quote:

even among children who manifest a major degree of discomfort with their own sex, including an aversion to their own genitalia.

Even WPATH—World Professional Association for Transgender Health—whose clinician-activists spend a good deal of time promoting younger and younger ages for “transition,” acknowledges on page 12 of its Standards of Care that most trans-identified kids grow out of it:

In most children, gender dysphoria will disappear before, or early in, puberty.

An earlier online version of  the WPATH SOC-7 cited specific numbers—greater than 80%–and included research citations, but this more specific information, oddly enough, has disappeared. But this 2014 study remembers:

…as the World Professional Association for Transgender Health notes in their latest Standards of Care, gender dysphoria in childhood does not inevitably continue into adulthood, and only 6 to 23 percent of boys and 12 to 27 percent of girls treated in gender clinics showed persistence of their gender dysphoria into adulthood.

Ok. So most kids grow out of gender dysphoria. But that fact doesn’t by itself dispense with biological evidence for gender dysphoria, whether or not it persists.

Traditionally, feminists have staked their claim on the “nurture” side of the “gender identity is innate” argument, with little acknowledgement of the findings in biology and neuroscience that hint at any real difference between male and female brain physiology.  And there is plenty of hard science bolstering this nurture-based stance: recent MRI studies have mostly corroborated the view that male/female brains are more alike than different, which leads to the conclusion that sex-role stereotyped behaviors are primarily the result of socialization, as Cordelia Fine laid out in her “Delusions of Gender.”


Trans activists and the clinicians who (let’s face it) follow their lead obviously point to other studies of adult transgender people which support the idea that their brains are hard-wired to be closer to the sex they “identify” with. Some of these studies do offer some evidence for sex differentiation in the brain. But imaging studies of adult brains are pretty much impossible to control, because all adults have had life experiences and social influences (not to mention possible cross-sex hormone treatments in some cases) which, owing to neuroplasticity, will of course have an impact on brain structure.

But even in the (primarily MRI) studies of adult brains that are better executed and controlled, it turns out the fundamental difference in these studied brains is not so much a matter of the subjects’ gender identity but of their sexual preference, as sexologist James Cantor draws attention to in a blog post surveying research studies frequently cited to prove a transsexual brain:

 In Scientific American Mind, journalist Francine Russo takes on a fascinating research question: “Is there something unique about the transgender brain?” she reviews some of the relevant brain research on transsexuals and concludes that transgenderism is indeed a phenomenon of the brain.  Although I agree with Russo that transgenderism is a phenomenon of the brain, I believe Russo over-focused on gender identity, which led her away from the better explanation of the data:

These brain scans don’t reflect gender identity, they reflect sexual orientation.

Cantor’s post, Russo’s Scientific American piece, and the cited research studies are all well worth reading.

There is some other research I find compelling: studies of prenatal hormone levels—specifically, testosterone—and their influence on sex-stereotyped behaviors and other characteristics in children.

A couple of years ago, Brynn Tannehill, a trans activist-journalist, posted a list of what Tannehill obviously considered to be airtight studies,  many of them revolving around prenatal hormones,  in support of innate gender identity . But are they airtight?

First, Tannehill conveniently neglects to mention that many of the cited studies (surprise, surprise) also show a link between prenatal testosterone levels and rate of homosexuality—in other words, hormone levels may have some impact on same-sex attraction.

But, more importantly, it turns out that several of the researchers linked by Tannehill have shown that the impact of hormones on both sexual identity and gender identity, while existing, is small. For example, Melissa Hines, in a 2006 paper, “Prenatal testosterone and gender-related behaviour, looked at several studies and concluded that

 Levels of prenatal testosterone predict levels of sex-typed postnatal childhood play behavior.

 Like what kinds of play behavior?

Research on girls and women with CAH has provided some support for the hypothesized influence of testosterone on human behavioural development. Girls with CAH show increased male-typical play behaviour, including increased preferences for toys that are usually chosen by boys, such as vehicles and weapons, increased preferences for boys as playmates and increased interest in rough-and-tumble play.

 Does this preference for rough-and-tumble, stereotypical “boy” play mean these kids are transgender?

Although there are fewer studies relating prenatal testosterone levels to postnatal sexual orientation and core gender identity, there is also some evidence, particularly from women with CAH or CAIS, that testosterone influences these psychosexual outcomes as well. However, these influences are substantially smaller than those on childhood play behaviour.





Prenatal testosterone levels are only a small factor in later sexual orientation and gender identity. What they are more predictive of is –wait for it—preference for non-sex-stereotyped activities! In other words: gender nonconformity (or my preferred term: gender defiance).

So some children play with stereotypically opposite-sex toys, prefer the hairstyles and activities of the opposite sex, and prefer the company of children of the opposite sex. Is it possible these preferences are at least partially “hard-wired” due to the effect of androgens on their brains? Sure. Does it follow that this means they are the opposite sex? Of course not. Nor does it necessarily mean they will grow up to be same-sex attracted, either (as I’m sure many heterosexual women who were tomboys can attest).

Let’s put a finer point on it: while some studies show that prenatal hormone levels could contribute to sex-stereotyped differences in human behaviors and, yes, sense of self, acknowledging these differences doesn’t lead to the conclusion that trans activists reach: If a child is born with a set of proclivities and tendencies more typical of the opposite sex, this means they ARE the opposite sex and medical and chemical alteration of the body is fully justified and should be pursued as soon as possible. 

What else does biological or genetic research show? In an earlier post, I argued that the only way to even begin to prove an innate male or female brain would be to scan a huge number of identical-twin newborns (before they had a chance to have any “nurture” influence—i.e., no social experiences), separate the twins at birth, then compare those brains later when the children grew up, some of whom would no doubt decide to undergo transition to the opposite sex.

For ethical reasons, this sort of research would be pretty much impossible (you can’t forcibly separate twins at birth and raise them separately, and you can’t control how kids are raised by dictating to parents how to raise them, even if you could). But an international team of researchers has looked at twins and the prevalence of gender dysphoria/transsexualism in a meta-analysis published in 2012, “Gender Identity Disorder in Twins: A Review of the Case Report Literature.”  (The full study is behind a paywall.)

Using a combination of their own clinic records and an exhaustive search of the literature, they examined a total or 44 twins of which at least one twin had gender identity disorder (GID)—the diagnostic term at the time, since replaced with “gender dysphoria” (GD). Of these, 23 were identical (monozygotic/MZ). The remainder were fraternal (dizygotic/DZ).

What were their findings?

 Nine (39.1%) of the 23 MZ [identical] female and male twins were found to be concordant for GID. In contrast, none of the 21 DZ [fraternal] twin pairs were concordant for GID.

This was a statistically significant difference, leading to the conclusion that “there is a role for genetic factors in the development of GID.” That difference in rate of gender dysphoria in identical twins matters. But let’s not lose sight of the fact that it was still a minority (39.1%) of identical twins who were both gender dysphoric.

Twin studies
In their discussion of their findings, the authors (like all truth-seeking scientists who submit their work to peer review) acknowledge that reality is nuanced:

The higher concordance for GID in MZ than in DZ twins is consistent with a genetic influence on its genesis although shared and nonshared environmental factors cannot be ruled out. Indeed, from these case reports, very little is known about the “equal environments assumption,” that is, the assumption that MZ twins are not treated more similarly than DZ twins in ways that might affect their gender identity.

In other words—“nature” appears to be a factor, but we can’t rule out nurture. ”Influence” is not causality.

And of even greater interest: In the penultimate paragraph of the discussion, we find this gem:

In the studies on genetics and sexual orientation, a higher concordance for homosexuality has been found in MZ versus vs. DZ twins. Using family methodology, there is also evidence for genetic influences [38]. In the reviewed case studies of twins with GID, from those whose sexual orientation is known, all, with the exception of Green [25], were attracted to their biological sex and nearly 50% of the non-GID twins were also homosexual, reflecting a higher percentage than found in the general population [39]. In all the cases reported to be concordant for GID, there was also concordance for sexual orientation.

Here we have it again. As Cantor noted, as I have noted, as the Dutch pioneers of pediatric transition have noted, this study finds—as nearly every study over decades has found: Whatever the precise contributions of nature v. nurture that leads to gender dysphoria or opposite-sex identification, a huge majority (if not 100%) of the studied individuals exhibit same-sex attraction by adolescence or adulthood.

I’ll hammer it home again: The constantly repeated refrain by trans activists that gender identity has “nothing to do with sexual orientation” is directly refuted in every study, as well as many of the personal accounts by trans-identified people splattered all over the media.

 So, what have we learned from looking at a few studies aiming to tease apart the nature-nurture question about gender dysphoria/opposite-sex identification?

  • there is sparse evidence of an innate male or female brain, and what differences there may be are mitigated and influenced by later life experiences. If anything, brain differences seem to indicate variations in sexual preference, not intrinsic gender identity; and
  • prenatal hormones—specifically, testosterone—have an effect, on….gender nonconforming behaviors in childhood. They have a contributing, but minor, effect on later homosexuality and gender identity; and
  • in general, there is evidence for both biological and non-biological (environmental-social) contributions to the development of gender dysphoria.

For me, it all boils down to this: Nature v. nurture is a false dichotomy. We are all the result of our genetic inheritance, hormonal influences, and how we were brought up and continue to live—which also includes both post-natal physiological influences (e.g., the various chemicals we imbibe in our hyper-industrialized world in addition to drugs and hormones we deliberately take in), as well as what we learn and experience over the course of our lifetimes.

In the end, the squabbling over nature v. nurture is a non-issue. What matters is protecting kids from the—however well intentioned—meddling of adults in children’s bodily and psychological integrity.  Whatever the relative contributions of nature and nurture to a child’s sense of self and ultimate decisions, adults should protect children from undergoing interventions that close off future possibilities.

Proponents of medical transition for children are not champions of gender nonconformity. If they were, as I’ve said many times, they would be celebrating it in children and instead of agreeing with the magical thinking of a child that this means they are “born in the wrong body,” they’d be helping these kids realize they are wonderful and unique examples of their natal sex. A healthy, fully functioning body attached to a brain is an integrated whole with that brain. It is an existential reality, no more “wrong” than the body of a person who demonstrates more sex-stereotyped typicality. By promoting the view that research evidence pointing to certain sex-stereotyped behaviors as having a biological component (however small) means kids’ bodies can be “wrong,” they are using science to limit the possibilities for children.

Puberty blockers, cross sex hormones, and surgeries for children and young people permanently limit their options. Options like: sexual experiences in an unaltered, non-surgically-tinkered-with body. Options like: Figuring out your sexual orientation, especially if you’re gay or lesbian and won’t, on average, come to terms with that fully until early adulthood. Options like: Being a role model for other kids that boys and girls can be and do or be anything, regardless of whether they fit into sex-stereotyped-typical behaviors and appearances.

Yes, a person who later decides to “transition,” who undergoes hormone treatments or surgeries after puberty may not “pass” as well as a someone who had natural puberty curtailed (and was incidentally permanently sterilized in the process). But the Cult of Passing as the opposite sex should be challenged—especially since those same trans activists who worry so much about “passing” (in perhaps their most obvious self-undermining argument) want us to also believe (for instance) that a “penis can be female.” To play Devil’s Advocate with the trans activists, if a boy’s penis can be female, you have no business promoting medical transition for anyone’s child.

Puberty blocking is not a benign intervention. While I’ll grant that, if stopped in time, GnRh agonists are “reversible” (as in, they will not prevent natural puberty), the psychological and neurological effects of delaying natural puberty cannot be seen by any thinking person as “fully reversible.” Neither is social transition “fully reversible,” for that matter. You can’t “reverse” a childhood spent cementing the idea that biological sex can be changed by a society bent on denying the existential reality of sexual dimorphism. You can’t “reverse” a message, repeated over and over to a child by trusted adults that there is something fundamentally wrong with his or her body that must be corrected.

Regarding nature-v-nurture?  Here’s what I’d say to my fellow kid transition critics:  Don’t dismiss the stuff from the “nature” side because you’ve pre-decided that any science supporting an innate contribution to gender dysphoria is a priori bunk and it’s all nurture/socialization.

In my opinion, taking seriously the dogma of the other side, examining it closely, and then coming to well-thought-out, nuanced conclusions is a much stronger place to operate from than dismissing out of hand any kernel of truth “they” might be obsessing over. That’s not truth seeking; that’s just being close-minded in service of an impenetrable ideology.

Nature-nurture—it’s both. Just like our thought-generating brains are indivisible from the bodies they’re a part of.

Your thoughts?

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

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

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

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

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

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

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

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


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

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

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

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

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


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

LisaM strawman

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

lisam gay lesbian

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

Rixt Arlene.jpg

Rixt Arlene part 2.jpg

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

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

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

LisaM cisnormative

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

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

better sterilie than dead.jpg

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

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

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

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

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

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

LisaM says:

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

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

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

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

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

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

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

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

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

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

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

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

**Sexual Orientation Change Efforts = sexuality reparative therapy.

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

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

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

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

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

Here’s what I’m willing to grant:

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

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

That’s pretty much it.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



Guest post: Why do WPATH & the APA scorn desistance?

This post is written by overwhelmed, a 4thWaveNow community member and mother who recently wrote about her own daughter’s desistance from trans identification. Her personal experience inspired her to submit this piece about the current effort by some activists and gender specialists to discredit decades of peer-reviewed evidence that most children with gender dysphoria do indeed change their minds.

Stay tuned for an upcoming post by 4thWaveNow that will take a closer look at the anti-desistance meme being propagated by proponents of  pediatric “transition.”

 by overwhelmed

There should be regulations in place to protect our children from harmful medical interventions. I think most people would consider this statement a matter of plain common sense. But unfortunately, common sense seems to fly out the window when “trans kids” are involved. More and more gender dysphoric children are being treated with puberty blockers, cross-sex hormones and even surgeries at young ages.

Trans activism has been busily exerting political influence on the medical field.  Being closely tied to LGB has given the T legitimacy (even if the aims of T conflict with those of the LGB). Trans activists have helped convince the public that gender identity is comparable to sexual orientation. They insist that helping children become comfortable with their birth sex is as abominable as conversion therapy is to homosexuals; that it is bigoted to want a child to avoid being transgender, just as it is bigoted to not accept a person as gay. But, the thing is, unlike the T, the LGB doesn’t require all of these medical treatments. And, unlike the T, the LGB just want people to accept their sexual orientation. Besides political gain, there really is no good reason to conflate gender identity and sexual orientation.

Recently, trans activism forced the closure of the CAMH Gender Identity Clinic in Toronto. In response to this closure, sexology researcher Dr. James Cantor  posted a compilation of childhood gender dysphoria research going back many decades on his site Sexology Today:

Following the closure of the CAMH Gender Identity Clinic for children, I have been receiving requests for what the science says.  Do kids grow out of wanting to change sex, or does it continue when they are adults?

 In total, there have been three large scale follow-up studies and a handful of smaller ones. I have listed all of them below, together with their results. (In the table, “cis-” means non-transsexual.) Despite the differences in country, culture, decade, and follow-up length and method, all the studies have come to a remarkably similar conclusion: Only very few trans- kids still want to transition by the time they are adults. Instead, they generally turn out to be regular gay or lesbian folks. The exact number varies by study, but roughly 60–90% of trans- kids turn out no longer to be trans by adulthood.

Cantor shared his post on the the World Professional Association for Transgender Health (WPATH) Facebook page. Although WPATH supposedly promotes evidence-based care and research, the vast majority of WPATH Facebook commenters appear to have strongly held opinions that contradict WPATH’s professed mission. Many state that once someone identifies as transgender, they will be transgender for life (regardless of the age of realization). Some commenters say it is a right for anyone (gender dysphoric or not) who wants to have these medical interventions.

When confronted with Dr. Cantor’s research compilation, there were many attempts to discredit the information. Some commented that the studies were old, flawed, invalid, and called them “junk science.” But others were more confrontational:

kills people

fuel to fire

Another commenter, Colt Keo-Meier, trans activist academic and recent (2013) psychology graduate from the University of Houston, is currently the co-chair of the Committee for Transgender People and Gender Diversity, Division 44 of the American Psychological Association (APA). This committee issued guidelines a few months ago that effectively put a damper on the clinical judgment psychologists and social workers can use when treating their gender nonconforming and trans-identified clients (more on these APA guidelines shortly).  Keo-Meier apparently believes that a child’s persistence in a transgender identity is to be desired.

colt comment

The last commenter on Cantor’s thread I will mention is Jenn Burleton (of “In a Bind” fame), who here discounts the research compiled by Dr. Cantor (referred to by Burleton as “Mr. Candor”) as flawed, while bragging about the 0% desistance rate of the over 200 kids seen at Burleton’s TransActive Gender Center.


Jenn Burleton seems to celebrate the 0% desistance rate, but the fact that it contradicts decades of prior desistance research should raise alarms. What approach do they use at the TransActive Gender Center to obtain these “impressive” results?

Here are TransActive Gender Center’s “Best Practices” :

transactive best practices

So gender-confused children seen at TransActive are affirmed as the opposite sex, socially transitioned, and treated to the “empowerment” of pubertal suppression, cross-sex hormones and surgeries. Is it any wonder these kids don’t desist? They are literally being conditioned to keep believing something is wrong with their bodies. Additionally, these socially transitioned children, even if they did start to have doubts, will likely feel tremendous pressure not to go back to their birth sex. Adolescence is already challenging enough without these complications. Just imagine how difficult it would be for a child in public school to start out as Jennifer, but later change to John.

As it turns out, the American Psychological Association (APA) recommends the affirming and accepting approach that Jenn Burleton has put into action. (As an aside, it should be noted that five of the ten members of the Task Force responsible for the guidelines were transgender themselves.) The APA Guidelines mention two different approaches for working with gender dysphoric children, but only one of them is deemed ethical. As you read, please keep in mind that “TGNC” has been defined as Transgender and Gender Non-Conforming people, in effect, conflating these two groups of children:

 One approach encourages an affirmation and acceptance of children’s expressed gender identity. This may include assisting children to socially transition and to begin medical transition when their bodies have physically developed, or allowing a child’s gender identity to unfold without expectation of a specific outcome (A. L. de Vries & Cohen-Kettenis, 2012; Edwards-Leeper & Spack, 2012; Ehrensaft, 2012; Hidalgo et al., 2013; Tishelman et al., 2015). Clinicians using this approach believe that an open exploration and affirmation will assist children to develop coping strategies and emotional tools to integrate a positive TGNC identity should gender questioning persist (Edwards-Leeper & Spack, 2012).

Notice how there isn’t any warning about possible negative consequences of the affirming and accepting approach? Just keep validating these kids and telling them it is possible to become the opposite sex. There seems to be no concern from the APA that all of this affirming will condition the child into believing they are transgender (when they may have desisted).

The APA guidelines do mention a second approach, though:

 In the second approach, children are encouraged to embrace their given bodies and to align with their assigned gender roles. This includes endorsing and supporting behaviors and attitudes that align with the child’s sex assigned at birth prior to the onset of puberty (Zucker, 2008a; Zucker, Wood, Singh, & Bradley, 2012). Clinicians using this approach believe that undergoing multiple medical interventions and living as a TGNC person in a world that stigmatizes gender nonconformity is a less desirable outcome than one in which children may be assisted to happily align with their sex assigned at birth (Zucker et al., 2012). Consensus does not exist regarding whether this approach may provide benefit (Zucker, 2008a; Zucker et al., 2012) or may cause harm or lead to psychosocial adversities (Hill et al., 2010; Pyne, 2014; Travers et al., 2012; Wallace & Russell, 2013). When addressing psychological interventions for children and adolescents, the World Professional Association for Transgender Health Standards of Care identify interventions “aimed at trying to change gender identity and expression to become more congruent with sex assigned at birth” as unethical (Coleman et al., 2012, p. 175). It is hoped that future research will offer improved guidance in this area of practice (Adelson & AACAP CQI, 2012; Malpas, 2011).

The APA felt the need to add on some warnings to the “embrace their given bodies” approach–just as WPATH members scolded Cantor that encouraging a child to align with their natal body is UNETHICAL. Seemingly defying common sense, we have literally come to the point that it is considered immoral (and in some areas illegal) to help a child feel comfortable with their body.

Yes, I said illegal. In more and more places, legislators are making the “embrace their given bodies” approach unlawful. Since 2012, the United States has banned gender identity “conversion therapy” in California, New Jersey, Illinois, Oregon, the District of Columbia and the city of Cincinnati, Ohio. And, in Canada, the practice has been banned in Ontario.

As parents who haven’t bought into the truth of our children’s sudden trans self-diagnosis, we have found ourselves in the position of going against the advice of WPATH and the APA. We want our children to realign with their bodies, to once again be whole, to be healthy. Desistance is our goal. We are not being transphobic, we sincerely care about the health of our children. We don’t want to “affirm” them as the opposite sex and validate that there is something so wrong with them that it leads to cross-sex hormones, surgeries and becoming lifelong medical patients. Transitioning should be a last-ditch effort, something to be used only when all other options have been thoroughly exhausted.

These guidelines and legislation, however, have made it difficult, and in some areas impossible, for parents to find mental health professionals willing to help their children (many of them with pre-existing mental health issues) feel comfortable in their bodies. Trans activists are using their influence to change medical guidelines and legislation to align with their strongly held beliefs, despite the scientific research that contradicts them. Instead of having desistance as a goal, they are working hard to make it a myth.

Mom forces insurance company to cover double mastectomy for her 15-year-old, with support of WPATH & Dan Karasic, MD

A 15-year-old cannot vote, sign a contract, drink, or get a tattoo. You can’t rent a car until you’re 25 years old. And in the US, the FDA has just proposed regulations to prevent minors from even using tanning beds.

Why all the restrictions? Well, last I checked, developmental psychologists, cognitive scientists, and informed members of the general public were aware that adolescents don’t have the cognitive wherewithal—the judgment, foresight, or awareness of future consequences–to make major, life-changing decisions, let alone suffer a bad sunburn. There has been so much replicated behavioral and neuroscientific research done on the subject of executive function in young people that it’s now considered settled science.

So the changes that happen between 18 and 25 are a continuation of the process that starts around puberty, and 18 year olds are about halfway through that process. Their prefrontal cortex is not yet fully developed. That’s the part of the brain that helps you to inhibit impulses and to plan and organize your behavior to reach a goal.

And the other part of the brain that is different in adolescence is that the brain’s reward system becomes highly active right around the time of puberty and then gradually goes back to an adult level, which it reaches around age 25 and that makes adolescents and young adults more interested in entering uncertain situations to seek out and try to find whether there might be a possibility of gaining something from those situations…one of the side effects of these changes in the reward system is that adolescents and young adults become much more sensitive to peer pressure than they they were earlier or will be as adults.

Another very readable (and amusing) article, “Dude, where’s my frontal cortex?,” sums it up thusly:

The frontal cortex is the most recently evolved part of the human brain. It’s where the sensible mature stuff happens: long-term planning, executive function, impulse control, and emotional regulation. It’s what makes you do the right thing when it’s the harder thing to do. But its neurons are not fully wired up until your mid-20s.

But the gender specialists at the helm of the World Professional Association for Transgender Health (WPATH) apparently never received the decades-old bulletin on adolescent brain development (or lack thereof), or so it seems. In the Brave New World of transgender “health care,” a 15-year-old can ask for and receive a double mastectomy, with mom’s blessing and collaboration. (In Oregon, a kid can decide to have her breasts removed whether mom approves or not, thanks to trans activists like Jenn Burleton and TransActive).

Last July, a mom posted to the WPATH public Facebook page, looking for advice on how to get “chest reconstruction” for her 15-year-old (i.e.,  double mastectomy. Why can’t these people use actual medical terminology, even amongst themselves? Do the providers and parents also get “triggered” by seeing a reference to female anatomy?)

[Note: For privacy reasons, I have chosen not to directly link to the (nevertheless) publicly viewable thread on the WPATH Facebook page.]

Seems mom’s insurance company balked at  covering elective removal of breast tissue in people under 18.

WPATH mom of 15 yr old

Psychiatrist Dan Karasic, one of the key contributors to the WPATH Standards of Care (SOC), and provider at the San Francisco Center for Excellence in Transgender Health, is happy to help, citing the SOC chapter and verse (page 21 to be exact) that WPATH fully supports “chest surgery” for minors, although it’s apparently still “too limiting” for his taste:

WPATH mom 2

Mom has already picked out the surgeon for her child, and another commenter, former Transgender Law Center employee Jason Tescher, recommends she try to “force” her insurance company to cover the cost (per the doctor’s website, $8500):


The WPATH thread went dark until today (more on that in a minute). But who is Dr. Mangubat?


In addition to being a popular presenter at Gender Odyssey, the yearly shindig for all things transgender, Dr. Mangubat is apparently well known as a surgeon who’s an easy touch for those looking for double mastectomies. As recently as six days ago,  underage top surgery seekers on Reddit were recommending him:

Also, the surgeon I went to (Dr. Mangubat) did not require any kind of letter and I don’t think he requires patients to be on T either, but I could be wrong on that. It was as easy as emailing his office to set up a consultation and then I was immediately able to schedule the surgery.

As to the mom’s efforts to get insurance to cover the removal of her child’s breasts,  an update appeared moments ago on the WPATH thread. Mom shares her good news: the insurance company has agreed to reimburse her for the double mastectomy that they “couldn’t wait for” and had done in August.

insurance appeal

Dr. Karasic couldn’t be happier.

karasic happy

It’s likely only a matter of time before insurance coverage for teen surgery will be the norm. The Obama administration recently proposed new rules that will require all insurance companies to pay for “transition” services. One wonders just how many “identities” the transgender umbrella will cover when it comes to federally mandated health care services?

The entire Reddit thread that references Dr. Mangubat  (as well as two other surgeons I’ve previously written about–Dr. Curtis Crane in San Francisco, and Dr. McLean in Ontario) is worth reading in this regard, because it’s primarily about “nonbinary” people who don’t identify as FTM getting access to “top surgery” on demand–exactly what providers like Dan Karasic promote and what is already happening, apparently, in San Francisco at taxpayer expense, as I detailed in a recent post.

As I also discussed in that post, Karasic is a major WPATH player pushing for the elimination of “gender dysphoria” as a requirement for “transition” services; he wants to  replace GD with a new diagnostic code, “gender incongruence,” which would do away with the need for any distress, dysphoria, or disorder but still allow for billing for what amounts to a lifestyle choice–for anyone who claims “gender incongruence,” on demand.

So we know Karasic and WPATH are OK with 15-year-olds who ID as FTM undergoing irreversible surgeries. Does he also believe, as he does for adult patients, that a 15-year-old (or 13-year old?) who identifies as genderqueer, gender fluid, or non-binary should ALSO get insurance-funded double mastectomies?


Activist-clinicians tout “cultural humility” & surgery-on-demand for “nonbinaries” & “genderfluids”

Update Dec. 31, 2015: Please see here for instructions on how to submit comments to the World Health Organization (WHO) on their proposed new diagnosis code “Gender Incongruence” and “Gender Incongruence of Childhood.” The public comment period will end soon, so time is of the essence.

A funny thing happened to me recently as I was trudging down yet another Got-Dysphoria?-Must-Transition-or Die rabbit hole.

I came to the realization that those of us who are wringing our hands over the rush to diagnose dysphoric children as trans are way, way behind the curve. That battle has mostly been won (and not in our favor).

Trans activists and “gender specialists” have moved on. Now, they are advocating for fully “depathologizing” transgender, yet at the same time, normalizing the idea that even part-time demiboys, “gender fluids,” and other assorted “nonbinaries,” aka “NBs” (the catchall term for anyone who doesn’t fall neatly into the trans man or trans woman box) deserve hormones and surgeries on demand— fully paid for by insurers.

It’s a neat trick they’re trying to accomplish: convince the public that being on the “trans spectrum” is normal, just like being gay or lesbian. Yet, paradoxically, extreme treatment is still medically necessary for some. How does that work?

As they have been all along, trans activists are riding the gay and lesbian liberation movement coattails to further their agenda. Once classified as a psychiatric disorder, homosexuality is now considered normal; it was removed from the DSM (the Diagnostic & Statistical Manual of Mental Disorders) in 1973. In other words, being gay or lesbian has long been depathologized—in my view, a very good thing.

Now trans activists are pushing for the same thing for transgender. In the DSM-IV, “gender identity disorder” (GID) was the label for what ailed a person who wasn’t happy with their biological sex. That was replaced by  gender dysphoria in the DSM-V. No longer a “disorder,” it was the name for the feeling of discomfort or distress with one’s sex.

The next step?  Activists and gender specialists (I’m starting not to see a lot of difference between the two) want to get rid of the idea of distress or dysphoria as a prerequisite for “transition.” The new term they’re after is “gender incongruence:” a mismatch between one’s idea of gender and one’s actual biological sex. The talk amongst activists and clinicians is that there is no disorder, dysphoria, or distress of any kind necessary to obtain services. “Gender incongruence” is a normal variation in human experience.  But you still need some code to be in the DSM, because–reimbursement. You know, billing.

Funny: When homosexuality was depathologized, the need for billing and treatment for that former “disorder” disappeared entirely.

(Note: The screen capture below was taken from a 9/24/15 post on the WPATH page which, oddly, has since been removed. )

wpath gender incongruence

But wait: How can something that is normal still require treatment? Major, possibly lifelong, medical procedures and drugs?

Let’s hear from one activist-clinician who can explain this a whole lot better than I can. Because it turns out, in certain places, this depathologized-yet-highly-medicalized normal variation is already being implemented as a matter of policy, and fully paid for by the taxpayer. And not only that: you don’t even have to have full time “incongruence” to get your breasts or penis lopped off, on demand. You get it just because you say you need it. And if your gender clinic operates under the increasingly common “informed consent” model,  no psychologist or psychiatrist is going to stand in your way. You, and only you, will have the right to diagnose yourself as needing the wallet-busting fully funded services of plastic surgeons and endocrinologists.

Dan Karasic, MD, is a psychiatrist affiliated with the San Francisco Center for Excellence in Transgender Health. He also is a key player in WPATH and one of several activists and clinicians crafting revisions to the DSM and the WPATH Standards of Care (SOC).

Karasic is quite active on the WPATH public Facebook page, frequently advocating for depathologization and greater access to surgery and hormones for those on the “gender spectrum.” [Please note: The WPATH Facebook page is viewable by the public, so all the information revealed in the screenshots below, as of this writing, is a click away.]

As Dr. Karasic says here, the San Francisco Department of Public Health will fully fund surgeries for even “nonbinary” folks:

WPATH Karasic cultural humilty and SFDPH cropped

Lest any wayward clinician have questions about the wisdom of all this, doubts are no longer acceptable. Acceptance and understanding are not enough in San Francisco. One must have humility. And that extends to “nonbinaries.” Only they/them know. They/them get to decide. Not you, with your outmoded and quaint “clinical judgment.” (Question: If you’re nonbinary, what would you be transitioning to? Oops, sorry. Humility lapse here.)

There are several members on the WPATH Facebook page who agree that any skeptical doctors (such as, evidently, some at San Francisco General Hospital–SFGH) need to be brought firmly into line, and that nonbinaries should get their top surgery too. 

WPATH top surgery for non binaries

Are nonbinaries only receiving surgeries and hormones in cutting-edge San Francisco? Apparently not. In March of this year, WBUR Boston touted reported on medical treatments for nonbinaries on the US East Coast in Not Male Or Female: Molding Bodies To Fit A Genderfluid Identity. 

Jones is part of a growing group of young adults who are genderfluid and are using hormone therapy and surgery to create bodies that matches this identity.

“It’s molding my body to fit my mind, physically changing myself so that I feel more comfortable as a person,” said Dale Jackson, a 33-year-old author who lives in Atlanta. Jackson takes a low dose of testosterone for two reasons. First, because he’s worried that a full dose would exacerbate his anxiety. And second, because a half dose helps him moderate the effects.

I like the idea of being in the middle,” Jackson said. “This allows me to explore my masculine side, but I don’t want to push it too far.” Jackson does not want a big bushy beard or arms so hairy “that gorillas were looking at me like, is that our cousin?”

Comfort, exploration, wants, not wants–what’s not to like? And it’s certainly important to calibrate the testosterone dosage so as not to increase pre-existing anxiety.

Both Jones and Jackson are under the care of physicians who are helping them pursue a more gender neutral body. But there are no guidelines. So far, in the emerging world of transgender medicine, protocols assume that patients want to end up on one end of the spectrum or the other, male or female, says Dr. Tim Cavanaugh, who runs the transgender health program at Fenway Health.

An estimated 100 to 150 of Fenways Health’s 1,500 transgender patients are genderfluid. Most of the genderfluid patients are transitioning from female towards male. So how do doctors know how much testosterone will produce the effects these patients are looking for?

To a certain extent we’re making it up, but I’d like to think of it more as finessing the regimens that we have based on the individual person’s desires and needs,” Cavanaugh said.

Ten percent of your caseload is “genderfluids” who are trying to “mold” their bodies to be more “gender neutral.” And most of them are female. (Wouldn’t a paragraph asking why that is be of value here? Silly me. That’s old school journalism.)

“There are no guidelines”—yet. And if you’re genderfluid, you are transitioning “towards” the opposite sex (even though, presumably, if you’re “fluid” you’re already somewhere in between, but the logic of gender identity is not…logical).

…some genderfluid patients say they cannot find peace without medical intervention.

“I had an incredible amount of dysphoria around my chest, it was consuming. I got to the point where in order for me to thrive and to do the work I wanted to be able to do and just live my life, I needed to have surgery,” said Taan Shapiro, a 33-year-old a teacher and parent in Boston who had surgery to create a flatter, more masculine looking chest.

Shapiro, who uses the pronouns they and them, says some strangers assume they are a teenage boy, others that Shapiro is female. Shapiro is not planning any more surgery or hormone therapy.

“Where I am is where I’m at and I feel good about myself,” Shapiro said, “[in a place] somewhere between male and female.”

This sounds an awful lot like elective surgery. People get procedures like breast augmentation, liposuction, face lifts, tummy tucks, to “feel more comfortable.” Someone might even say they need a taxpayer-funded nose job to “thrive” and just “live their life.” That the “incredible amount of dysphoria” they experience because of their big nose is all consuming. (Likely the late Michael Jackson would have agreed.)

To be fair, Dr. Cavanaugh does voice a few words of doubt about all that money he’s making the wisdom of medical treatment for nonbinaries:

If gender is a product of social construction, then using medicine to fix every patient’s discomfort may not be the best long term solution, Cavanaugh says.

“I hope we are headed to a place where we recognize that gender is not one thing or the other, not male or female, and that culturally we can become more comfortable with that idea,” Cavanaugh said. “Hormones and surgery are always going to be options for people, but I really hope that we won’t feel compelled to use them as much as we do now.”

Hm. I wonder what other means there might be to address people’s discomfort with a socially constructed gender identity?

The WBUR article was discussed on the WPATH Facebook page, and some members were not pleased with this meek bit of dissension in the ranks: the medical model is the way to go!

WPATH nonbinaries surgery critique wbur

So there you have it.  It’s “super problematic” for Dr. Cavanaugh to suggest that some “nonbinaries” (i.e, people without rigid gender-stereotyped personalities) aren’t going to be served by the “medical model.”

How will activist-clinicians continue to walk the delicate line between normalization/depathologizing the “trans spectrum” while still hoodwinking encouraging the taxpayer to pay for expensive plastic surgeries and long-term hormone treatment? Stay tuned!

For now, there’s lots more to read in this thread on the WPATH Facebook page. Rest assured that the activist-clinicians are hard at work to make sure insurers are on board with any and all treatment, on demand, for transmasculine, transfeminine, genderfluid, and nonbinary folks. After all, gold-plated body modification is not just for the garden variety, binary transgender man or woman. That is so 2013.

But sarcasm aside (for now), if these activists and clinicians are really serious about depathologizing? Here’s what they’d do:

Celebrate gender nonconformity. Teach people to respect and take care of their bodies, just as they are.  Work to build self esteem in teens, and mentor them to know that their bodies, the product of millions of years of evolution, are good and whole, and that there is no need to cut or drug themselves to be “comfortable” or to fit anyone’s idea of male or female. Develop therapies that help people realize their bodies and brains are not two disconnected units, but indivisible, complete,  and right. Encourage kids to dress, think, and pursue interests as they like. Celebrate uniqueness and diversity in men and women.

I realize my prescription for truly depathologizing gender nonconformity might put a few people out of work. But our kids are worth it. Aren’t they?