Staring The Future In The Face: How Many Of Us Will Be Left?

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What kind of world will the child trans trend lead to?

Marcus Gregory

“So we allow as many as thirty per cent of the female embryos to develop normally. The others get a dose of male sex-hormone every twenty-four metres for the rest of the course. Result: they’re decanted as freemartins structurally quite normal (except that they do have the slightest tendency to grow beards), but sterile. Guaranteed sterile.”

 Aldous Huxley, Brave New World

Throughout the developed English-speaking world, gender nonconforming boys and girls are now routinely coerced into transgender identities. Cross-gender play, clothing and claimed identity in children is seen through a lens of the child being transgender, with the favored route being to sexually transition the child. The trend is activist-driven, and not based on anything like science: Miranda Yardley, Stephanie Davies-Arai, and Stephen Levin have written recent articles discussing the fundamental flaws in these ideas.

What I want to discuss is the long term impact on gay and lesbian populations of widespread, early child transition, which we can expect from changing guidelines for transition. Many gender nonconforming boys and girls would grow up to be gay and lesbian if left alone. Widespread transitioning of children, based on diagnostic criteria for gender dysphoria that include gender nonconforming behavior, should target children who would have otherwise become normal homosexual or bisexual adults. But most children also don’t end up homosexual. Can we make any predictions about this new world?

Clues from childhood research

To understand where the trans trend might go in future, we can use recent psychology research from Melissa Hines’ group at Cambridge University. Her graduate student Gu Li examined a database of 4,500 UK children whose gender-typical play behavior was tracked in early childhood. The childrens’ behavior was assessed on a scale called the Preschools Activities Inventory or PSAI: on this scale, 0 corresponds to most feminine, 100 to most masculine. At 15, the children were asked, via anonymous computer interview, about their sexual experiences and preference. Li found very strong evidence children who were homosexual or bisexual in adolescence tended be gender nonconforming, much more often than children who reported being heterosexual.

Compared to heterosexual adolescent girls, lesbian girls were 12–19 times as likely to display extreme levels of gender nonconforming behavior at ages 3.50 and 4.75 years; compared to heterosexual adolescent boys, gay boys were 20–26 times as likely to display extreme levels of gender nonconforming behavior at ages 3.50 and 4.75 years.

Some of these sexuality-related differences in gendered play behavior were almost certainly biological, as there is widespread encouragement for nearly all kids to conform to gender roles. That’s also in line with the knowledge that girls with a condition called CAH, who are exposed to more testosterone in the womb, tend to be more masculine in play and preferences.

While being gender nonconforming, as measured on the PSAI scale, isn’t the same thing as a diagnosis of gender dysphoria, there is a strong connection. Transgender education in UK schools tells children they have “pink and blue brains”, and that children with gender-atypical behavior are transgender. In Australia, under the “anti-bullying” Safe Schools initiative, young children are taught “for about 4% of people their gender may not align with the sex they were assigned at birth”, with an intense focus on “affirming” gender nonconformity as being transgender. When children who are forming a sense they are boys or girls are constantly told being gender nonconforming means they are transgender, they will probably go along with it.

Worldwide, the large, recent increase in such referrals supports the idea cultural factors are making nonconforming kids into “trans kids”. For example, referrals to the Tavistock, the only gender identity clinic in the UK that deals with minors, have gone from 96 six years ago, to over 2000 this year. In the US, there are now nearly 100 child gender identity clinics. And in Australia, an “epidemic in transgender children” has been noted in the wake of the Safe Schools program. The tactics used by trans ideologues to promote this ideology to children and punish dissent seem cultish, if not totalitarian. If transgender ideas about children become fully accepted, referrals to gender clinics should become very common for gender nonconforming children.

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Tweets reporting the Australian Safe Schools program’s impact on children in Victoria (“Vic”) presented at a conservative conference.

Moreover, Li’s paper supports a connection between nonconformity and dysphoria (emphasis mine):

Another line of evidence […] comes from clinically referred children, many of whom demonstrate extreme cross-gender behavior that partially or fully meets the diagnostic criteria for gender dysphoria/gender identity disorder [in the DSM]

A future scenario: who will transition?

Let’s consider a “Brave New World” future where socially transitioning nonconforming children by age 5 becomes commonplace. A critical question is how many children will continue to a medical transition. This should not be a small fraction, for the following reasons. First, we should expect social transitioning “locks in” kids: they can form a sense of identity as the opposite sex. Second, there will be a significant barrier for a socially transitioned boy to change his mind, since peers and adults will have invested in his transgender identity and stepping away may cause embarrassment.

Social transition also sets up the expectation the child will go to the “next step”: puberty blockers, HRT and then sex reassignment surgery. This is becoming easier, younger: new WPATH guidelines lower the age hormones can be used, and some within WPATH are proposing there should be no lower age limit for surgery. We might expect socially transitioned gay and lesbian kids are less likely to socially de-transition than straight kids, due to opposite-sex attraction being more socially approved. Li reported:

The current study found that not only levels of gender nonconformity, but also change in gender-typed behavior across the preschool years related significantly to later sexual orientation, especially in boys. When heterosexual individuals, who comprised the majority of participants, increasingly conformed to respective gender norms, nonheterosexual individuals appeared to conform less, or became more nonconforming, over time.

Still, using Li’s study, we can say something about the impact of transitioning many young children in our “Brave New World” scenario. This generation would otherwise make up the young gay and lesbian population in 15-20 years, the late 2030s. Li provides the proportions of children who are effeminate boys and masculine girls at age 4.75, broken down by their PSAI gendered behavior score, and by their sexual orientation at age 15.

Admittedly, there aren’t many 15-year-olds who report being gay and lesbian in this study: 24 gay boys and 16 lesbian girls. That means there’s a lot of uncertainty, and only rough estimates are possible. It might well be some more of those adolescents will eventually realize they are gay or lesbian.  It’s also harder to look at the impact on children who say they are bisexual at 15, since detailed figures on their behavior weren’t supplied.

To assess the impact of common childhood transition, we assume in this future scenario, children are transitioned who are markedly gender nonconforming. Imagine all boys with PSAI scores below a certain number, and all girls scoring over a certain number, will end up transitioned. Using Li’s paper above, I’ve graphed the proportions of gay and straight boys who’d be transitioned, if this happened to all boys with PSAI scores below a certain point.

If 5-year-old boys with PSAI scores under 45 or so (more effeminate) are socially transitioned, this would affect about 15% of gay boys and perhaps 1% of straight boys. But because only 1.1% of boys in this sample declared they were gay at age 15, we expect many boys who weren’t claiming to be gay by this age would be transitioned, too.

Using child PSAI score distributions in Li’s Table 4, I’ve also plotted the percentage of transitioned boys who would be gay or bisexual against the percentage of all boys who would transition in this scenario. Even if the most gender nonconforming 0.2% of boys are transitioned, much less than current estimates of the US trans population, about 75% of those transitioned boys will say they are heterosexual by 15.

A somewhat different picture emerges for girls, as transitioning gender nonconforming girls with a PSAI score above 55, would transition 25% of all girls who could go on to be lesbian at age 15, but about 1% of all other girls. That is: girls who go on to be lesbians are relatively more gender nonconforming than boys who go on to be gay.

Finally, I’ve plotted the percentage of transitioned girls who would be lesbian or bisexual as a function of the percentage of all girls who are transitioned. For this, I used child PSAI score distributions from Li’s Table 3, although the number of lesbian or bisexual girls here was quite small. Transitioning the most gender nonconforming 0.3% of girls at age 5 would result in about 30% of transitioned girls being lesbian or bisexual. This would decline to under 20% if transition hit 0.8% of all girls.

Brave new world: social impacts of wide transition

In our society that devalues those who don’t meet stereotypic gender expectations, modern medicine offers a route back to conformity by way of transition, which many parents, children and teens are only too happy to take. This “Brave New World” future where most gender nonconforming children are coerced into sterilizing, body-altering “treatment” might seem dystopian, and close to Iran-style gay conversion. But due to trans activism and changing medical and educational practice, it’s undoubtedly starting to happen, and we can try to assess the impact on the lesbian, gay and bisexual population.

However, what the data above shows is many young children who are gender nonconforming, and thus at high risk of being transitioned, are not necessarily going to be homosexual. This might be surprising, but James Barrett, the head of the UK’s Charing Cross Gender Identity clinic, wrote a paper showing some boys referred to gender clinics are heterosexual: of ten feminine boys, only one became transsexual and four became heterosexual. This is also in line with 4thWaveNow’s recent articles on the Tumblr community, showing many male-attracted teen girls identifying as “trans gay men”.

The pediatric trans trend appears to represent a fundamental break from previous concepts about who goes on to transition. Instead, making child transition normal may have a broader effect on children and teens, especially girls, and well beyond those who are very nonconforming. Up to 5 percent of girls in certain schools, or in one survey even up to 12 percent of young people, appear to place themselves on the trans spectrum.

A social trend of prepubescent transition would go with transition of gay, lesbian, and nonconforming teens being commonplace. Another uncertainty is whether sexually aware, latent autogynephilic male teenagers might transition. Miranda Yardley has written about this recently. We should not understate the impact of a potential cultural fixation where teenage boys think enjoying gender-bending pornography means they are transgender. Ironically, in a worst-case where many children go on to medically transition, these factors could have the most serious impact on lesbians while potentially giving a large increase in the “trans lesbian” population. By the 2030s, the typical young “lesbian” could be male.

In this analysis, I’ve explored the consequences of putting young gender nonconforming children down a medicalized path. The impact of this alone would be the erasure  unnecessary risky medicalization, sterilization and destruction of their gay/lesbian identity  of about 1 in 4 of those lesbians who know their identities in adolescence, and 1 in 6 such gay men. To be sure, it often takes gay and lesbian people significantly longer to come out, even to ourselves. But at every step through childhood, the presence of transgender as a possible identity to take on, acts as a kind of sink, that traps gay and lesbian kids. And, it seems, a surprising number who would be straight, but are gender nonconforming.

Marcus is a gay scientist. He tweets @LogicalMarcus

Technical note: For the proportion of children transitioned vs PSAI cutoff plots, I extracted the PSAI score distributions broken down by sexual orientation of age 4.75 children from Figure 1 of Li, Kung and Hines. For the proportion of children transitioned who are homosexual or bisexual vs total transitioned plots, I calculated this from the means and standard deviations of the 3-group intercepts of Tables 3 and 4 for age 4.75, assuming normal distributions and the same proportions of sexual orientations as their reported numbers. To check a normal distribution assumption wasn’t misleading, these plots showed broad agreement with similar plots calculated from the detailed distributions of Figure 1 for homosexuals and heterosexuals only.

Transgender Children — a Risk Management and Ethical Perspective

The author is an ex-Risk Manager for a U.K. Mental Health Trust , not a doctor or psychologist.  Views here reflect the author’s understanding of this issue from a Risk Management and Allied Health perspective.

I am concerned at the perceived lack of clarity, ethics and judgement regarding assessment, diagnosis and treatment protocols for transgender people, especially children.

Terminology & assessment criteria: There is no agreed, organic, definitive test for Gender Dysphoria – the feeling that your sex assigned at birth and gender identity do not match. DSM V says that a patient can have a diagnosis of GD if the distress caused by the feeling that they are in the wrong sexed body for their I.D. is ‘consistent, insistent and persistent’ in children and if it carries on over 6 months for adults. Gender is defined as the social norms accepted for sex – male/female according to culture. Yet we hear there are multiple genders, not just ‘man/woman’ including ‘gender-fluid’ and ‘agender’- by definition not consistent, insistent and persistent. There is research to suggest that many gender non-conforming children grow out of the feeling that they are the opposite gender to their body by adolescence. I would like to add, from a professional point of view, that the feeling of ‘being in the wrong body’ for one’s sex must be especially difficult to assess when it is applied to babies and toddlers who do not yet have an understanding of objects, words and language.

Differential diagnosis: In order to be ethical and for treatments to work, clinicians must be able to establish the nature of a disability or health problem, including a mental health problem. They must be able to discount other factors including for example, social contagion, emotional trauma, schizophrenia, body dysmorphia associated with sensory difficulties, Autism Spectrum Disorder, effects of medication, brain injury etc. This does not appear to be happening in the case of people who think they may be transgender. We seem to be relying on self-diagnosis for this group, especially regarding case histories coming from the U.S.  We also need to look at the qualifications, skill-set and autonomy of specialist gender professionals who are making the diagnosis, to ensure consistency and efficacy. I am concerned that diagnosis is being made on the basis of one or two visits to counsellors who are then able to confirm distribution of medication which could permanently affect patients e.g. Testosterone.

Medical ethics, Clinical Governance, Risk Assessment, Informed Consent.

Medical ethics has four main principles:

  • Autonomy

Requires that the patient have autonomy of thought, intention, and action when making decisions regarding health care procedures. Therefore, the decision-making process must be free of coercion or coaxing.  In order for a patient to make a fully informed decision, she/he must understand all risks and benefits of the procedure and the likelihood of success.

  • Justice

The idea that the burdens and benefits of new or experimental treatments must be distributed equally among all groups in society. Requires that procedures uphold the spirit of existing laws and are fair to all players involved.

  • Beneficence
    Requires that the procedure be provided with the intent of doing good for the patient involved.
  • Non-maleficence
    Requires that a procedure does not harm the patient involved or others in society.

These appear to be breached in some cases:

Autonomy:

    1. The decision making process can be demonstrably proven NOT to be free of coercion or coaxing, if the choice is being given to parents of possibly transgender children, ‘Would you rather have a dead son, or a transgender daughter?’ as has been reported.
    2. Fully informed decision: this ties into another medical principle of informed consent. You cannot give informed consent if you have not been given full information and you do not understand what you are consenting to. Basically, what are the outcomes of social transitioning on children/adults? What are the outcomes and possible side-effects of puberty blockers e.g. Lupron? What are the outcomes of adult surgery? Does it relieve psychological pain? Where are the clinical trials to show effectiveness/non-effectiveness in short-term and long-term follow-up studies?
  • As medical, allied health and social work professionals, are we acting effectively and ethically when we are advocating a course of action, are we giving our patients/clients full information so that they can make a clear and informed autonomous decision?

Justice: Existing laws show that medical, allied health and social work professionals must give full information to patients based on risk and clinical governance protocols. We need to be informed of and explain trials and their outcomes. Are we giving full information based on clinical trials i.e. Does this intervention work? What are the risks involved? What are the risks of doing nothing? I would argue that we do not yet have clear evidence from clinical trials.

Beneficence: The procedure is provided with the intent of doing good. How can we measure this if we do not have the medical and social evidence that social and medical transitioning is effective and not harmful?

Non-maleficence: Procedure does not harm the patient involved or others. Surgical and medical intervention on otherwise healthy bodies is a harm in and of itself unless it can be proven otherwise.

SUMMARY:  Risk Assessment: Clinical, Non-Clinical and Financial. 

For risk managers, there appears to be a clear risk to legal, medical and ethical cover from referral to treatment and follow-up with transgendered clients, as outlined above. We need to look at the legal implications of informed consent. We must ask ourselves the question: Is it legal or ethical to obtain a signature for intervention from a potential patient who has not undergone a full assessment and consultation process, who has not been informed of likely clinical outcomes and/or long-term effects of intervention and who also may be unfit to consent because of coercion, language comprehension, cognition or mental health difficulties.