Careful Assessment is Not Happening

This recent article highlights a phenomenon that many concerned about the teen trans trend are seeing regularly – the extensive screening that many in the public believe happens before a young person is referred for hormones or surgery isn’t happening. According to the article, the parents called several therapists looking for someone who could help their newly gender dysphoric daughter explore and manage these feelings.

“Every therapist we spoke with – and we spoke with quite a few – told us that if a teen says they are trans, then they are, and the parents’ job is to affirm and help them transition. There was no therapist who would say to Abby, ‘This is not my experience of you.’  No therapist was interested in exploring the possibility that something other than being born into the wrong body could be operating here.”

Very similar accounts can be found on the blog 4thwavenow.

Like many who read this blog, I phoned gender therapists during the weeks after her announcement that she was trans. Without even meeting my child in the flesh, all four of these therapists talked to me like this trans thing was a done deal. I wrote about one of those conversations here. One very friendly therapist, who identifies as FTM and whose website stressed “his” commitment to “informed consent,” assured me that there was no need for my daughter to first experience a sexual or romantic relationship before deciding whether she was trans. “Most of the young people just skip that step now,” the therapist said.

When I speak of my concern about this trend to those unfamiliar with this issue, one of the predictable responses is that my fears must be misplaced because extensive therapy is required before any treatment can begin. There is no need to worry that a young person might undertake permanent, drastic alterations to his or her body, because anyone who doesn’t really need this treatment will be identified by professionals.

Unfortunately, this is not always the case.

This article in Slate describes the shift away from gatekeeping to informed consent. Even gender clinics that focus on children and youth such as Mazzoni operate under an informed consent model. If the child or teen declares themselves trans and consents to treatment along with the parents, that is all that is needed for treatment.


Here is an example of a consent form of testosterone therapy.

One of the most striking findings of the detransitioner survey conducted by Cari Stella is that 65% of those who medically transitioned had no therapy at all.  The pattern appears to be the same in the US and the UK. Screening is minimal to non-existent. The model is affirmation and informed consent. If you say you need this treatment, your healthcare provider will not stand in your way.

A Reddit user posted about their experience at a gender clinic. This user was approximately 19 years old when they sought treatment. This user was pleased with the lack of gatekeeping they experienced.

Dr. Timmins was unconcerned about the patient’s history of self-harm, and was careful not to question the patient’s motivation. From this account, it does not appear that Dr. Timmins explored the patient’s mental health history very deeply.

He did offer the helpful suggestion of freezing eggs, since testosterone can affect fertility. One would think that, given the acknowledged reality of severe side effects of treatment, it would be advisable to assess and counsel more carefully, but this account clearly indicates that did not happen.

Instead, Dr. Timmins had other advice:

The doctor recommends getting lots of visible tattoos, to make sure the patient isn’t mistaken for a 12 year old boy.  Stay away from the arm, though. You might need that skin for phalloplasty.

Taking a look at some of the poster’s other comments elsewhere on Reddit, we learn that they have a history of sexual trauma, abuse, depersonalization and derealization, dissociation, substance abuse, and self-harm.

It would seem to make sense that a history of any one of these issues might make a health care provider want to assess and counsel thoroughly to make sure that the desire to transition was not a maladaptive coping mechanism. But these kinds of considerations don’t seem to apply in transgender medicine.

In the US, Dr. Johanna Olson Kennedy is one of the leading pediatricians working with trans identified youth. She is explicitly against any kind of gatekeeping, as she made clear recently on the WPATH Facebook page.

I would point out that gatekeeping for serious medical intervention is indicated not because trans people are mentally ill, but because it is standard practice in medicine to evaluate the appropriateness of any treatment before prescribing it, especially if that treatment has a potential for adverse consequences. Any parent knows that a child’s self-diagnosis of an ear infection is unlikely to result in a prescription for antibiotics. Responsible physicians will take the time to examine the patient to see if such treatment is really indicated. Wouldn’t this seem even more necessary when the treatments are associated with serious side effects such as loss of fertility or liver damage?

Dr. Olson Kennedy appears unconcerned about potential regrets. For those who change their minds later, bodily changes and possible sterility will have all been part of their “gender journey.”

Which brings me to my final point. Our Reddit poster contends that they are happier now that they are taking testosterone, and that they are certain this is the right course. Even if one transitions for the “wrong” reason, where is the harm? If this is a treatment pathway that really helps some people, why shouldn’t we make it available to them?

Because we have no idea what the long-term effects of being on cross sex hormones will be. Because we have sufficient reason to be concerned that there could be serious adverse effects. Because if someone transitions as a maladaptive way of coping with trauma, the time spent transitioning may be time lost to healing. Because there are certainly ways of addressing dysphoria that are less risky. 

For those of you coming to this issue for the first time, it simply isn’t the case that young people are being carefully evaluated before being put on medications that are being used off-label and have not been studied for their safety long-term.

14 thoughts on “Careful Assessment is Not Happening

  1. Thank you for this informative and timely post. The more information that comes to light about the dangers of medication and surgery, especially on young bodies, the more the professionals involved seem inclined to rush into them, to the exclusion of any other therapeutic approach. One begins to question exactly what sort of agenda may be involved here.

    Liked by 4 people

  2. It’s clear that the precepts of medical ethics are not being adhered to. ‘Informed Consent’ does not mean signing away your rights, it means, being able to understand what you are signing up to, without coercion, and with full understanding of short and long-term effects.

    This isn’t happening. Informed consent means just that – you can’t legally consent without being fully informed of the consequences of what you are consenting to, otherwise it isn’t ‘informed’. This is the basis of laws re. having interpreters and sign-language interpreters, speech pathologists in court to explain what language-compromised witnesses can understand and what they are capable of explaining in speech and language. This is also why there are children’s courts, children aren’t psychologically or emotionally mature enough to understand and give consent, this is why it is illegal to have sex with under age children (among other things!). They cannot consent. Why is language being co-opted to mean its exact opposite? This is the opposite of ‘informed consent’. This is coercion at best, de-frauding a person of money for something that doesn’t work and actual bodily harm at worst. No, I take that back, this is Actual Bodily Harm with deception and fraudulent taking of money. Disgusting.

    Liked by 3 people

  3. When you’re 18, you understand a WHOLE LOT and are absolutely sure of what you want in life. Right? of course. Try a rational, logical discussion with an 18-year-old about what they’ve already decided is a right move for them. Now try doing that with an 18-year-old suffering early stages of bipolar disorder or some other mental health condition, including undiagnosed autism spectrum. Good luck.

    Sex change via Informed Consent at age 18, no problem….just don’t plan to drive to the clinic in a rental car….you can’t rent a car yet for some reason. And don’t celebrate your new prescription for testosterone with a stiff drink….you can’t legally drink alcohol yet for some reason.

    Young adulthood based on the legal age of 18 is still that…teenage years. Teens are well known to be impulsive, peer-following risk-takers. And this is the time when many mental health conditions first appear. Yet we trust them to judge the risks involved with taking cross-sex hormones. Just sign here….

    My 19-year-old female child has been 1 year on testosterone via an informed consent clinic. “He” was affirmed on “his” college campus and is absolutely sure “he” is happy for the rest of “his” life. It is astonishing how quickly this potent hormone can change a female body. “His” voice is deeper than “his” male companion’s voice by far (apparently they see themselves as a gay couple)….permanently changed whether “he” remains a transman or not. Happiness can be fleeting, as true adults fully understand. Good health plays a huge part in happiness.

    My hope for other families is that careful assessments for 18+ (to age 30 perhaps) are reinstated as no lay person should be judged as able to truly be informed about this complex life-changing decision. “Informed consent” is a misnomer.

    Liked by 7 people

    1. Nervous Wreck, your comment hit home. I too am the parent of an 18-year-old sudden-onset “transboy” who is desperate to take testosterone. We have a real therapist who has diagnosed her as on the spectrum, but we are well aware that an informed consent clinic may be in her future. Fighting back against this blatant medical malpractice is enough to make one despair.

      Liked by 1 person

    1. To be fair, many of the gender clinics do employ a multi-disciplinary approach. I think the problem is more that everyone has a “gender lens.” If the young person uses any of the language associated with a trans identity or dysphorie, (and this language can be easily imbibed online), then gender dysphoria is immediately assumed to be the primary diagnosis, and transition the only treatment. Other mental health issues are either assumed to be a result of being transgender, or are assumed to be no impediment to transition.

      Liked by 2 people

  4. With all of the instances of treatments that have later proved to be harmful (I’m thinking of the lobotomy article), it behooves doctors to move slowly and carefully. But what am I saying? This is from the same medical community that prescribes Ritalin like it’s candy. I guess it’s to be expected but it’s no less upsetting.

    Liked by 3 people

  5. I did a spit-take when I read this:

    What’s really sad is that once people tell the appropriate “transcript” and get their “letter” or stamp of approval from their most often cis provider…

    Did Dr. Olson-Kennedy just tacitly admit that yes, rapid-onset trans kids are “reading from a script” provided by the trans subculture when they interact with their doctor (and their parents, their school, et cetera?) That certainly seems to be the implication of this passage. She uses what’s clearly a subcultural slang term, acknowledges it as such with quotation marks, and (very important) appears to take for granted that her audience in WPATH will understand what she’s referring to.

    Parents in the gender-critical blogosphere often remark that it sounded like their kids were reading from a script (“Are you saying trans people don’t exist? Would you rather have a dead daughter or a live son?”) But I thought gender “experts” were supposed to reassure us that no, no, no, these kids are expressing their deepest inner identities, totally isolated from any possible peer influences or social trends.

    Liked by 1 person

  6. Bravo! And thank you. I did not transition until I was an adult. Looking back, I know I wouldn’t have been able to make a truly informed decision in adolescence. It’s not only important to know what potential risks are involved with hormone replacement therapies and surgeries, but to UNDERSTAND what the choice means. Thanks again!


  7. I will echo what has been written here. My child has Type 1 diabetes and so was already seeing an endocrinologist regularly. The endo was also a gender endo – and instantly after my kid mentioned new name and pronouns during intake, she offered blockers.
    Even after we declined because we didn’t know the effects on diabetes or bipolar, she offered the blockers at subsequent appointments. After declining blockers for a year or so, she started to offer cross-sex hormones. She didn’t seem troubled at all that my kid wasn’t receiving therapy for gender issues but for bipolar disorder. Not troubled at all that my kid had a history of aggression and antisocial behavior and was developmentally delayed.
    He was over 15 when she offered estrogen therapy, so it was his choice. (Thankfully he heard what I said about the unknown impacts to his other life-threatening illnesses, as well as recognizing the truth in my assertion that the genderists are too quick to hand out potentially life-threatening drugs without critically examining whether they’re called for.)


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