Transgender Kids: Are We Doing More Harm Than Good?

by Todd A. Whitworth

Before we start I’d like to disclose a little about myself to inform you the reader that I am not coming to this subject void of experience. I am a female to male transexual man. I started my transition in 1993 by changing my name and gender pronouns. I took a year before I began the physical part of my transition in 1994 with hormone replacement therapy, I was 21. I remain glad that I made the choice to transition, and that I took the time I did to explore that it was not just a phase.

The movement to support children transitioning from one gender to the other may be causing more harm than good. For the purpose of this piece, I am asserting that there are two genders male and female. Transitioning from one gender to the other is a long, expensive, and invasive process. It involves hormone replacement therapies for the rest of one’s life and several expensive surgeries which may or may not yield the result the individual wants. No amount of hormone therapy and surgical intervention is going to change biological reality. This is not a choice to enter into lightly and it’s highly suspect that a child has the maturity and cognitive ability to truly make an informed decision. A person’s brain is in development up to the age of 25. Perhaps we should wait before helping our children to transition.

No one is totally happy with who they are, and right now trans is trendy being comfortable in your the sex you are born into and corresponding gender role, is not. Cisgender, a word I’ve come to detest, is a term used for individuals who are not trans. It gets continually used as a bullying tactic to shame kids who are ok with their biological sex and the gender that matches their sex. I am a trans person, and I do not advocate for anyone to be made to feel ashamed for being happy with who they are.

We, humans, are social animals. We start to learn how to navigate in society when we are kids. We yearn for acceptance and understanding, we want to fit in. This makes sense because at one point in our history, to not fit in, to be socially ostracized, to be thrown out of the village, meant certain death.  Of course, kids want to fit in and be accepted it’s natural, and being ostracized, feels awful.

Something to remember we are dealing with children. Kids go through phases, just because your little boy puts on a dress one day, does not make him a girl. Say your little girl likes rough and tumble play and sports over dolls? It doesn’t make her a boy. Hormones sterilize and surgery is very expensive. Once puberty starts the body begins to change and hormones start to surge the child may become more comfortable with their biology. Maybe your kid is transgender, maybe they aren’t, before becoming their biggest cheerleader for transition maybe let nature take its course and see what happens. Gender dysphoria, formerly Gender Identity Disorder is a mental health diagnosis, and it’s not that common as gender advocates would have you believe. Don’t take my word for it, look up Gender Dysphoria in the current DSM V[1]. Gender dysphoria is persistent, pervasive, and causes ongoing distress. It meets the criterion for a mental health diagnosis, not a phase.

In summary, kids are not adults, and they need our care and guidance. They are immature, impulsive, and try on lots of different identities in an attempt to fit in. One of those identities may be transgender. I am not arguing that Gender dysphoria won’t present in childhood, it may. I am arguing for pause before fully diving into super advocacy mode. I am not a parent, but I do know that most parents want to do the best for their children to protect them, support them, and stand by their decisions to help them thrive and grow. That being said, it is also the job of the parents to help their children by keeping them safe from harm, including decisions they may not be ready to make yet.

 

 

 

 

 

 

 

 

 

[1] The Diagnostic And Statistical Manual of Mental Disorders is meant to be used by mental health professionals not laypeople.

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.

A Letter to the APA

Psychotherapist Lisa Marchiano sent the following letter to the APA in support of Justine Kreher of thehomorarchy.com. For  months, Justine has been tirelessly sending letters to LGBT organizations on this topic.

Lisa blogs on parenting at https://blogs.psychcentral.com/big-picture-parenting/ and blogs on Jungian topics at http://www.theJungSoul.com. She can be found on Twitter at @LisaMarchiano.

March 6, 2017

Dear Members of APA Division 44:

I am writing this letter in support of my colleague Justine Kreher of thehomoarchy.com. (Her letter can be found here.) I am a licensed clinical social worker and Jungian analyst who has consulted with dozens of families who have a transgender identified teen. My experience with these families has shown me that parents want to protect their child from drastic and potentially harmful medical intervention that may not be necessary.

I have many concerns about the role of psychologists and other mental health professionals in affirming a young person’s self-diagnosis as transgender, and encouraging immediate social and/or medical transition. For the sake of brevity, I will focus on the following four areas:

Potential Harm to Gay, Lesbian, and Bi Children

I am aware of the APA’s position on sexual orientation conversion therapy (i.e. therapy intended to ‘convert’ gay individuals into heterosexual individuals). The first strong position came out in 1997: http://psychology.ucdavis.edu/rainbow/html/resolution97_text.html and then a stronger position later: http://www.apa.org/about/policy/sexual-orientation.aspx

The APA has taken an unequivocal stance against conversion therapy. Gender reassignment evaluation and treatment, without strong guidelines and oversight in place, amounts to the same outcome as conversion therapy – implementing a treatment for a problem that hasn’t been scientifically established to exist, with the intent of creating a change that hasn’t been proven to be therapeutic (or is only therapeutic in some cases). I encourage the APA to take a strong position against pediatric transition practiced without careful oversight.

There is plenty of anecdotal evidence reported by clinicians who see families with gender nonforming children that parents are uncomfortable with the thought of having a gay or lesbian child. Many of these parents feel more comfortable having a transgender child. One example appeared in this article in The Atlantic.

Catherine Tuerk, who runs the support group for parents in Washington, D.C., started out as an advocate for gay rights after her son came out, in his 20s. She has a theory about why some parents have become so comfortable with the transgender label:

“Parents have told me it’s almost easier to tell others, ‘My kid was born in the wrong body,’ rather than explaining that he might be gay, which is in the back of everyone’s mind. When people think about being gay, they think about sex—and thinking about sex and kids is taboo.”

In the recent BBC documentary “Transgender Children: Who Knows Best?” Dr. Ken Zucker shared that he had had families say of their trans kids, “Well, at least they’re not gay.”

Kimberly Shappley, whose transgender daughter was featured in the March, 2017 HBO special Vice was clearly disturbed by the thought that her little boy was exhibiting pre-gay behavior. The following quote is from this news article.

“I am a devout and conservative Christian and an ordained minister,” she said and explained that she tried to force Kai into being a boy when she was a toddler. “I knew my kid was different before the age of 2,” Shappley said. “My child was very feminine, flamboyant and dramatic. No matter how I tried to punish, reshape or discipline her, she continued being very feminine.”

In this news article, Shappley admits that friends and family were questioning whether Kai was gay before Shappley allowed her child to transition. Says Shappley:

“I was very concerned, because at the time I was leading a small ministry at my church and teaching Bible study, and here I have this kid who people in my family were flat asking me if this kid was gay.”

While Shappley’s story may be an especially clear cut case where a parent appears to be more comfortable having a gender conforming “straight” trans child than a gay or lesbian child, tales such as this are not uncommon.

Keeping this in mind, consider the recent longitudinal study that found high rates of gender nonconforming behavior among gays and lesbian in early childhood.

Abstract. Lesbian and gay individuals have been reported to show more interest in other-sex, and/or less interest in same-sex, toys, playmates, and activities in childhood than heterosexual counterparts. Yet, most of the relevant evidence comes from retrospective studies or from prospective studies of clinically-referred, extremely gender nonconforming children. In addition, findings are mixed regarding the relationship between childhood gender-typed behavior and the later sexual orientation spectrum from exclusively heterosexual to exclusively lesbian/gay. The current study drew a sample (2,428 girls and 2,169 boys) from a population-based longitudinal study, and found that the levels of gender-typed behavior at ages 3.50 and 4.75 years, although less so at age 2.50 years, significantly and consistently predicted adolescents’ sexual orientation at age 15 years, both when sexual orientation was conceptualized as two groups or as a spectrum. In addition, within-individual change in gender-typed behavior during the preschool years significantly related to adolescent sexual orientation, especially in boys. These results suggest that the factors contributing to the link between childhood gender-typed behavior and sexual orientation emerge during early development. Some of those factors are likely to be nonsocial, because nonheterosexual individuals appear to diverge from gender norms regardless of social encouragement to conform to gender roles.

Given the high rates of gender nonconforming behavior in gay and lesbian children; the high desistance rates of gender dysphoria; that as yet there is no reliable way to determine which dysphoric kids will desist and grow up to be well-adjusted lesbian, gay, or bi adults; given that puberty blockers followed by cross sex hormones lead to permanent sterility 100% of the time, it is crucial that careful clinical guidelines be developed that will help to prevent gay and lesbian children being lead down a path that leads to permanent sterilization and other medicalized intervention. Since the APA has taken a strong stand against conversion therapy, the organization should also speak out against what is in practice a form of medical gay conversion therapy.

Lack of Evidence Regarding Outcomes

Currently, the evidence related to transition outcomes is relatively poor. In June of 2016, the Centers for Medicare and Medicaid Services (CMS) denied coverage for gender reassignment surgery after a year-long review determined that there was not sufficient evidence that these treatments were therapeutic. From the report:

Based on a thorough review of the clinical evidence available at this time, there is not enough evidence to determine whether gender reassignment surgery improves health outcomes for Medicare beneficiaries with gender dysphoria. There were conflicting (inconsistent) study results – of the best designed studies, some reported benefits while others reported harms.

The overwhelming majority of the evidence about transition was derived from studies done on adult transitioners. There are only a few studies that look at outcomes among those who transitioned prior to age 18. De Vries et al. noted positive outcomes among pediatric transitioners. However, the sample size of 55 was relatively small. In addition, it seems worth pointing out that the original group being studied consisted of 70 young people. One of these was not included in the study because the individual died from postsurgical necrotizing fasciitis after vaginoplasty. In addition, these young people were assessed for the final time at approximately one year post surgery.

In contrast, consider the study conducted by a young female detransitioner. Though not peer reviewed research, this study offers one of the few glimpses into the experience of those who transitioned and then went on to re-identify as female. (Honestly, I find it sad and telling that the only research being done on this growing group is being conducted by the young women themselves.) Cari Stella’s study was open for two weeks. During that time, more than 200 detransitioned women responded. The results are enlightening. Most chose to detransition because they found other ways to deal with their dysphoria. While participants in the De Vries study were assessed for a final time at least one year post operation, the women who answered Cari’s survey reported that the average time they spent transitioning was four years. It seems possible that some individuals in the De Vries study may become less happy over time with their outcome.

It is also important to point out that those individuals in the De Vries study were carefully screened, assessed, and followed. In today’s climate of immediate affirmation, young people are receiving hormones after only a handful of therapy sessions. This of course may make it more likely that they may come to regret these interventions. From Cari’s survey:

117 of the individuals surveyed had medically transitioned. Of these, only 41 received therapy beforehand. The average length of counseling for those who did attend was 9 months, with a median and mode of 3, minimum of 1, and a maximum of 60. I’d like to have something cool to say here, but I’m honestly just stunned at the fact that 65% of these women had no therapy at all before transition.

Cari’s findings corroborate what I am hearing from parents and seeing online. With good intentions, gender therapists are quickly affirming a trans teen’s self-diagnosed identity. However, this may mean that other factors get overlooked.

Cari’s survey and the writings and videos of detransitioners around the web make it clear that many who underwent transition feel that they were doing so as a maladaptive coping mechanism to deal with trauma, anxiety, social difficulties, or other issues. The majority of detransitioners speaking out online now identify as lesbian, and many of them feel that internalized homophobia played a part in their believing that they were men. Many express having been harmed by their transition, and some refer to it as “medically assisted self-harm.” Here is just one excerpt from the writings of a detransitioner discussing how she was harmed by transition:

I transitioned FTM at 16, was on testosterone and had a double mastectomy by 17. I’m 20 now and back to understanding myself as a lesbian, like I was before I found out about transition and latched onto it as a way to “fix” body issues created by the challenges of growing up in a deeply misogynistic and lesbian-hating world.

I absolutely am traumatized by what happened to me, and I’m not the only one. I’m a part of support networks for women who stopped transition that have over 100 members, and that’s just the individuals who have gone looking for others with this experience and found us. I’ve met more than a dozen of these ladies in person at different times… we’re definitely real.

Plenty of others who transition, whether they continue or not, live with complicated feelings about what happened. Not all of us name those experiences the same way, search for community to process that pain, or ever “go public” to any degree. This is trauma.

Hormone therapy really wasn’t that safe, in my experience. I remember being 17 and watching my pediatric endocrinologist literally Google dosing information right in front of me. Didn’t inspire confidence. The doctors controlling my HRT had no idea what they were doing, at least with patients like me. They were all just as confused about how to treat me medically as they were about how to interact with me as a human being. When I was on testosterone and taking Adderal for ADD, I got heart palpitations, chest pain, and shortness of breath. I didn’t tell anyone because I didn’t want to have to choose between a psych med that was making a huge difference in my ability to function in the workplace and hormone therapy, and I didn’t want to acknowledge that what I was doing was dangerous.

Early in my transition, I went through menopause. This caused vaginal atrophy and drip incontinence that has persisted for years. I piss myself slowly all day now; it’s really not cute or fun. I refused to acknowledge it was connected to the HRT-caused vaginal atrophy that immediately preceded its onset until months after going off testosterone. Yeah, I signed a paper saying I knew that could happen. I also thought this treatment was my only hope for coping with the intense feelings of alienation/disgust with my femaleness. I was wrong. Transition didn’t help. It did harm, harm that I now have to learn how to live with on top of all the shit I thought transition would fix.

Practice norms in this area are alarmingly based more on activist agendas than evidence. Take for example Diane Ehrensaft, PhD. She is a thought leader in pediatric transition, and the Director of Mental Health and founding member of the Child and Adolescent Gender Center at UCSF. She has written and published widely, and is often cited as an expert. She writes about helping children find their “true gender self,” and states that the clinician needs to go through a careful process to differentiate between the persisters, desisters, and the genderfluid – or the “apples,” “oranges,” and “fruit salad,” as she names them. However, she cites almost no research to help us understand how she makes these determinations. As stated earlier, we do not currently have criteria that can definitively identify which children will persist. In this short video clip, Ehrensaft reveals her casual disregard for the fact that the treatment path towards which she leads families will permanently sterilize the child.

Social Contagion

Until recently, the evidence for social contagion among transgender identified teens was strong, but anecdotal. For example, a therapist wrote a blog post in which she described whole friend groups coming out together. Fortunately, there is some research currently being conducted that is attempting to document social contagion among transgender identified teens.

This transgender trend looks strikingly like other social contagions to which adolescents are known to be prone. There is considerable research on suicide contagion among teenagers. There is also a great deal of research on social contagion in eating disorders. To take just one example, Paxton et al. demonstrated that a teen girl’s use of extreme weight-loss behaviors is closely linked with whether her friends use them. From the study:

This study explored friendship variables in relation to body image, dietary restraint, extreme weight-loss behaviors (EWLBs), and binge eating in adolescent girls. From 523 girls, 79 friendship cliques were identified using social network analysis. Participants completed questionnaires that assessed body image concerns, eating, friendship relations, and psychological, family, and media variables. Similarity was greater for within than for between friendship cliques for body image concerns, dietary restraint, and EWLBs, but not for binge eating. Cliques high in body image concerns and dieting manifested these concerns in ways consistent with a high weight/shape-preoccupied subculture. Friendship attitudes contributed significantly to the prediction of individual body image concern and eating behaviors. Use of EWLBs by friends predicted an individual’s own level of use.

Paxton, S. J., Schutz, H. K., Wertheim, E. H., & Muir, S. L. (1999). Friendship clique and peer influences on body image concerns, dietary restraint, extreme weight-loss behaviors, and binge eating in adolescent girls. Journal of Abnormal Psychology,108(2), 255-266. doi:10.1037//0021-843x.108.2.255

Social contagion among teens is a rich area of literature for which many examples could be cited. This 2014 study found that teens who adopt an “alternative” identity such as “emo” or “Goth” were more likely to self-harm. This was true even after controlling for other factors. The authors point out that engaging in self-harm aids in reinforcing group identity among teens.

It is likely that we do not yet fully understand the enormously powerful role that social media can play in spreading social contagion. Many transgender identified teens report extensive time online on social media sites such as Reddit or Tumblr. On YouTube, there are tens of thousands of videos made by trans young people, documenting their transitions in a way that valorizes taking testosterone and estrogen, or getting a double mastectomy.

Consider this account from a young man found here:

So you have all these young men who don’t understand their sexuality, watching sissy porn. Eventually they are going try and find out what it all means.

This is where the trans ideology plays its part. The trans narrative sucks these confused young men like myself in with all the “answers.” You see many confused fetishists posting in places like reddit/asktransgender asking if they are trans. Whatever their questions are, the usual reply from these places is something like “if you could press a magic button that would give you a female body would you press it? If you thought about it, then you may be trans, because a “straight” guy wouldn’t hesitate for a moment.” They try to equate the masochistic thrill with a desire to be a woman. And once you fall for that they have you.

They create a very intricate web of bullshit that is very hard to see out of once inside. It is very cult like. Any non-kool-aid drinking source of information is deemed “transphobic.” Any therapist that doesn’t tow the line is a “gate keeper.”

Lastly, in discussing teen transgender identification and social contagion, it is crucial to keep in mind that teens are presenting with gender dysphoria in a way that was exceedingly rare even a short time ago. Until recently, most cases of pediatric gender dysphoria began in early childhood. With the onset of puberty, most children desisted, but some persisted into late adolescence. Research confirmed that cases of gender dysphoria that began in early childhood and persisted into late adolescence were extremely unlikely to resolve. In these cases, it made sense to assist the young person in transitioning. Now what we are seeing is significant numbers of young people coming out as transgender in adolescence (the most common age appears to be 14 or 15) without having had any prior history of gender dysphoria or even gender nonconforming behavior in many cases.

The major studies on using puberty blockers had very strict criteria of early onset of gender dysphoria and life-long gender dysphoria. Specifically- the studies did not include kids who had no gender issues in childhood and had the onset of gender dysphoria happening as a teen. It is quite an overreach to apply those studies to defend treatment for kids who have an out-of-the-blue onset of GD as a teen (often in the context of mental illness or social struggle) as if they are exactly the same thing. This rapid onset gender dysphoria appears to be an entirely new clinical presentation that may well indicate significant social contagion.

 Misuse of Suicide Statistics

In nearly every media article that discusses transgender children, a mention is made of high rates of self-harm and attempted suicide. Gender therapists often cite suicide statistics in attempting to convince parents to affirm their child’s trans identity and allow them to transition. The Williams Institute found that 41% of transgender people reported having made a suicide attempt at some point, and this statistic is frequently cited. The study’s authors admit that, because of the way the survey was conducted, the 41% number may be somewhat inflated. Taking this into consideration, we see that suicidality among transgender teens appears to be roughly similar in incidence to suicidality among gay and lesbian teens.

Most relevant to the discussion here is the complete lack of evidence that transition alleviates suicidality. The Williams Study, for example, does not indicate when the attempts took place – whether before or after transition. In fact, it may be the case that suicidality is higher among those who have transitioned.

Studies such as this one found that suicide rates were higher for those who transitioned. From the study:

“Those who have medically transitioned (45%) and surgically transitioned (43%) have higher rates of attempted suicide than those who have not (34% and 39% respectively).”

A long-term follow up study conducted in Sweden and published in 2011 found that suicide rates were significantly higher for those who had transitioned.

“Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population.”

A 2015 suicide cluster of transgender teens in San Diego included three adolescents who had been fully supported in transitioning by their families.

It bears repeating: There is no evidence that transition reduces suicidality among transgender teens. Suicidal young people ought to be treated for suicidality, not given body altering drugs. Nevertheless, gender therapists continue to use the threat of suicide to convince parents to allow their children to undertake irreversible medical interventions of dubious therapeutic benefit.

Thank you for taking the time to read my letter. I hope you will give the issues I have raised here careful thought.

Lisa Marchiano, LSCW, NCPsyA

Interview with a Detransitioned MtF

This post is an interview with a 26 year old former MtF. 
1.) First, could you tell me about your experience of dysphoria? I have the impression that this is probably experienced very differently by different people, so I am curious about the nuance of your individual experience. How did it feel? How did you know it was gender dysphoria? When did it start? Was it continuous? Or did it come and go? Anything you can share that would help me understand what that feeling was like.
I was depressed and suicidal in 2013. I saw someone in the counselling office of my college once a week on the recommendation of a doctor. I had recently broken up with a young woman I had lived with shortly, and the counselling focused on my repeated failing relationships with women including my mother. I blamed my incompatibility with the women in my life on the idea that there was a fundamental misunderstanding between us since I was actually a girl in a boy’s body. As in, how could I have successful mother-son or boyfriend-girlfriend relationships if I’m actually not a son or a boyfriend? That made perfect sense to me at the time.
2.) How did you learn about the term transgender?
I learned about the term transgender on the internet. I looked at a lot of trans stuff but I’m not very social online so I didn’t ask any questions or start any dialogue with members of the community I’d soon be sort of part of.
3.) How did you decide to transition?
I have been and still am embarrassingly narcissistic and obsessed with my identity. The first thing I changed was my name since I had already wanted to for the hell of it. My legal name is ironically a unisex name: Taylor. Ashley is another unisex name, which I chose as to ‘gently’ transition in the workplace and other real life situations. I didn’t show up one morning in drag. If I did it right it should’ve been a ~6 month morph into a somewhat female-looking creature.
4.) Tell me about your experience with the medical community. Did you seek therapy as you were deciding to transition? Were you offered alternative treatments for the feelings of dysphoria? What kind of assessment was done before hormones were prescribed?
I went to a walk-in clinic in my trans gear and said I wanted to see this doctor I knew of in town that prescribed hormone replacement therapy for people who identify as transgender. The doctor asked me less than a dozen questions and said okay. A week later I had a similarly short conversation with an incredibly suspicious endocrinologist who got me on estrogen the same day and I was off to the races. Less than an hour of face-to-face time with any sort of medical practitioner before I got my long-term hormone prescription.
I was 23 years  old.
5.)  What was it like to go on estrogen? Did it help? How so?
Estrogen was actually great. I admit I fucking love placebos, but I think the estrogen really made me super relaxed and calm. I felt happier and more optimistic despite still going through the weirdness of public transitioning, specifically at work.
6.)What was your experience being transgender? Did it help the dysphoria? Did you feel better overall? Worse? In what ways?
Transitioning made me happy in the sense that I felt I was changing parts of myself I didn’t like, but it made me even more obsessed with gender roles which were what I was supposed to be rejecting.
7.) Tell me about your detransition process?
I stopped taking the pills and stopped shaving. The doctor called once after I missed my next appointment, then never again. Then basically read nothing but radical feminist twitter for a while.
8.) What advice would you give to a young person considering transition?
Do not do it. Hating your body is a part of having a body. You can either live with it or not. If you change it you’ll still hate it even if you can tolerate it. You’ll brainwash yourself if you haven’t let others yet. It’s a cult based on sexual fetishism and pseudoscience. You’ll do something stupid or lose all of the people in your life then in 2030 when this whole thing is over you’ll never be the best version of yourself you could’ve been.

A Teen Therapist Writes About Gender Identity Issues — Sally’s Story

Sasha Ayad, M. Ed., LPC  is a therapist with extensive experience working with teens, and gender defiant teens in particular. When she started to notice her bright, creative gender defiant teen patients feel that they needed to define themselves by picking a label that then sometimes encouraged them to make permanent changes to their bodies, Sasha found herself thinking critically about this trend. She has researched gender identity issues in teens extensively, and has a private practice where she works to support gender questioning youth. In Sasha’s words

“I use non-judgmental, compassionate, dialogue that focuses on exploration rather than immediately seeking to affirm and transition your child. Together with your teen and family, we consider multiple complex factors that may contribute to their dysphoria, including social, cognitive, environmental, physical, and emotional factors. Treatments may include mindfulness, somatic, and integrative techniques as well as confidence-building, and age-appropriate sexual identity exploration. I also educate parents about the topic of gender identity, break down stereotypes, discuss risks, and encourage parents to become deeply invested in the process so they can best support their child outside of therapy sessions. While transition may be the best option for some kids, many others have had very painful and negative experiences with their transition, and I help families prevent this from happening. I believe I owe it to your child to be thorough and careful in my approach, placing safety, well-being, and happiness above all else.”

The following piece was posted originally on Sasha’s blog. While the current narrative around helping trans identified teens creates a false dichotomy between affirming a teen’s identity and being unsupportive or rejecting, Sasha’s work beautifully illustrates how one can offer unconditional support while helping a teen to navigate the confusing waters of identity.

Sasha can be reached at 888-945-8207 or  Sasha@Inspiredteentherapy.com. You can also find her on Facebook.

sally-blogI was busy working on a behavior plan for a very fidgety 6th grade boy when I heard an assertive knock on my office door. This was the third time this week Sally had left class without permission to come talk to me.

“Ms Ayad, how can I transfer schools? I really don’t think I can get a proper education here and none of the teachers know what they’re doing”, so began our 45 minute conversation. She often got fixated on one or two teachers, who despite their best efforts, could not find a good way to work with Sally. I had a very different relationship with her though, and I was able to help her work through some of her generalizations and logical leaps.

Her hair was always pulled back hastily in a low ponytail, the eczema around her mouth, though visible, wasn’t as noticeable as the smudges that covered her glasses – she pushed them up from the lenses every time. Often a curious little smirk would lift the corner of her mouth, even when she was clearly upset or discussing something serious.

She is one of those kids who teachers were often exacerbated by, but I got to see her in a different light, and I found her endearing, creative, and incredibly interesting.

Once we were able to conclude that switching schools was not the best option, and I taught her some self-regulation skill using a squeeze ball, it seemed she was much more at ease. She took a deep breath and said “Ms Ayad, can we talk about that other thing now?”

“You mean gender?” I replied. She nodded.

Sally and I had been talking for the last several months about her “gender identity”. When she first brought this up to another counselor, they referred her to me, knowing that I am experienced and confident in working with kids around this topic. However, Sally had certainly been exploring this issue online for months she brought it to the attention of her school counselors. Our first conversation on the topic made it clear that she had a broad vocabulary (straight from gender identity theory) which is not typical for most middle-school students.

My approach was patient, inquisitive, and I challenged her… just a bit. When she talked about her parents pressuring her to wear dresses and “act more like a girl”, I made a point of breaking this down, deconstructing what that means, and sharing ways that we all behave outside of gender stereotypes: and that’s a GOOD thing!

When she told me, weeks later, that she was looking for binders online and asked me to stop using the pronouns “her” and “she”, I felt deep pangs of worry, but took it slow. I asked her where some of these ideas were coming from: she was spending hours on tumblr, trans-advocacy sites for teens, and chat groups with other kids who she believed were “just like her”. I treaded very carefully, but told her about the medical dangers of binding and what the long term consequences may be. Our limitations in the school system made it hard to get too deep on these topics, but in every brief interaction with Sally, I found ways to empathize with her struggle, instilling pride in who she is, and still gently challenge her flawed ideas.

I deliberately pointed out all of the ways she doesn’t conform to gender stereotypes, without implying that she’s in the wrong body: her love of manga comics, her cargo pants, her disdain for dresses and “girly” clothes, in my eyes, made her a unique and awesome person. Hearing those compliments always brought that endearing little smile to her face.

Eventually, as her classroom behavior improved, her anxiety lessened, and she started making friends, she relied less and less on me for support that year. Several months passed and before I knew it, the school year was coming to a close. I wanted to follow up with Sally, so I pulled her from her PE class and we talked outside on a particularly nice, sunny afternoon.

I started with, “Sally, I’ve missed you, how are things going? It seems like we haven’t talked in forEVER!” A huge smile emerged on her face, and since her glasses were less smudgy than normal, I could actually see that her eyes were smiling too.

“Doing great! I’m getting along better with Ms Barnay and I haven’t been walking out of class when I feel frustrated”. We talked about the anime club, her plans for summer, and how her other classes were going. She paused, looking ready to tell me something that meant more to her than academics. “Ms Ayad, remember how we used to talk about gender a lot? Well, I’m kinda over it”.

“Ok, tell me what you mean by ‘over it’, Sally”.

“Well before, when I didn’t have any friends at school, I was meeting a lot of people online and I thought they were my friends. Then when I actually started hanging out with people in real life, things felt different. Before, I really wasn’t comfortable with myself so I felt like I needed to change. But now, I’m ok with myself”.

I nearly fell off the bench. This was one of the most profound realizations a therapy client can make – and she, even in her young 13 year-old body and mind, came to this conclusion by herself: “I really wasn’t comfortable with myself, so I felt like I needed to change. But now I’m ok with myself”.

I was grinning from ear to ear by this point. I told her how incredibly proud I was, that I was so happy she was feeling good about herself.

Over the summer I thought often about Sally’s story. While she turned things around largely on her own, I can’t help but wonder how things might have unfolded had I followed the prescribed gender identity model.

What if I had asked about using male pronouns?
What if I had been very supportive of her desire to bind her chest?
What if I had affirmed the idea that because she doesn’t like dresses and feels like she identifies with trans kids online, that she too may be a boy stuck in a girl’s body?

And what if I hadn’t directly (though gently) challenged some of her flawed beliefs – that stereotypes and clothing styles are a good foundation on which to question your biology, to modify your body parts, and to change your entire identity.

These are questions gender therapists HAVE to ask themselves, and it frightens me that most aren’t. Our kids are dynamic, different, and unique. But they also have insecurities, self-doubt, and are vulnerable to finding “solutions” in the wrong places. When a teenager feels isolated and misunderstood, trans-advocacy sites can convince them that hope lies in changing who they are. And isn’t this the opposite of what we’ve always tried to instill in kids: self-love, confidence, and embracing their uniqueness?

Regardless of the misinformation and wayward perspectives currently taking over the mental health field, I will continue to focus on self-acceptance for my clients. Sally’s story, and many others like it, will be our reminder that in counseling, self-loathing should never be promoted over self-love.

*The names in this story have been changed to protect the identities of the people involved.

Marcus lives in the United Kingdom. He can be reached at @LogicalMarcus on Twitter. He has provided an extensive bibliography at the end of this piece. 

   fireworks I am nine years old and at a Halloween party. I am playing with a boy my own age with black curly hair. As the fireworks go off I notice how beautiful he is. I never see him again.

    I am fourteen and unhappy. My school friends talk about girls all the time, and I can’t relate. I am becoming bookish and withdrawn. In the local college library I find a book by William Burroughs describing a wild life where men love other men in a city called San Francisco. I find the book exciting. I have never heard the word “gay” other than as an insult before.

    I am fifteen and at a sleep over with a male friend. We are watching porn. I am thinking about kissing him. I feel scared and the moment passes.

    I’m seventeen and I have a girlfriend. I was so happy to prove I am normal like my other friends. I didn’t care for kissing her, but I try anyway. I tell her I think I am bisexual and we argue. We break up three months later.

    I’m nineteen and I have slept with a boy for the first time. We met on the internet. He is a tall and handsome Indian boy. I am white. We did it in his car to Daft Punk’s Discovery album. For the first time I tell a close straight male friend I think I am gay. He is accepting and supportive.

    I’m twenty-two and my friends know I am gay. A few colleagues at work do too. I have some gay friends and I have dated a couple of guys. I am starting to feel comfortable being who I am. 

    I’m twenty-four and it is the mid 2000s. I am coming out to my parents. I planned it carefully. They have never made a homophobic remark but I have read accounts of coming outs going poorly, so I have waited till I am an independent adult. I tell them I have a boyfriend called Matt. They take the news with no real rancor. My father tells me to be careful about AIDS and my mother cries because I will not have children. We continue to love one another.

   Every gay and lesbian person has a story of how they came to accept themselves. Realizing you are gay can take a long time. It took me at least ten years, much denial, some unhappiness, and lasted until I was a grown man. There was never a moment as though a sign turned on in my head to say “You’re gay.” For a long time I tried to ignore it or bargain it away: I didn’t want to be one of “those” people, who seemed to be on the margins of society. Self acceptance and coming out were gradual, constant negotiations between my feelings and what I felt safe and comfortable saying, to myself and others. But I am just who I am, a gay man, and there is nothing wrong with that. The rest is society’s problem, not mine.

  As an adult I hoped growing up gay would be easier for children today. With what’s commonly called LGBT acceptance, gay and lesbian people are full legal citizens in many Western nations, and can marry, and have basic protections from prejudice. We are not yet full social equals – holding hands and kissing as a same sex couple can attract unwanted attention and be dangerous, “gay” is still a playground slur, and we rarely see our lives reflected in the media. But when I see young gay couples walking around, I feel intense pride and happiness that the situation is improving.

    Recently I have read many accounts of parents raising so-called “transgender kids”. This is a new thing, specific to wealthy Western nations and in particular the US, that did not exist when I was growing up. These are children who are held to be “female brains in male bodies”, or vice versa. The science does not support this claim: science shows that there are no male or female brains. These “transgender kids” are not diagnosed by scanning their brains. They are boys who prefer, in some way, “girl things”, or the other way around. These children are dysphoric, that is unhappy, specifically with the kind of things they can do as boys or girls. They can be as young as three or four. For example:

    Calls to help sex-change kids as demand for gender reassignment soars

    For such children, an increasing number go through the following regimen: social transition (dressed as the opposite sex), then subjected to increasingly invasive medical treatment: puberty blockers, then cross-sex hormones, followed by sexual reassignment surgery at adulthood or even mid teenage years. Transgender kids seem to be a trend in the USA and UK, and the numbers reflect that, with steep increases at “gender clinics”. But how is it possible so many children are just now being declared to be in the “wrong bodies”? This looks alarmingly like a kind of conversion therapy.  Studies (links below) have found that most children who express “gender identity disorder” did indeed desist and become gay adults in the past.

    As a gay man, who also has struggled at times to accept myself in a society that does not always accept me, it is troubling to see children encouraged to think their bodies are wrong for the way they behave or the way they feel. The root of this seems to be a conservative enforcement of the same stereotypes that make gay people suffer. Even when these children are said to declare they are in the wrong body I think it is plausible they are doing so out of an awareness some kinds of bodies are being allowed to do some things, but not others, and if you want to do those other things you had better have the other kind of body.  But surely it is better to tell all children that they can do, wear, and enjoy whatever they want without it being “wrong”.

I think there is a fad, or a contagion, going around parents and medical professionals, being pushed by motivated activists and fed by well-meaning liberals and echo chambers on social media, for declaring children to be transgender. Although society recognizes this as real, for example in educational material and school bathroom use, there does not seem to be solid science or evidence behind this condition being more than a cultural issue. I am concerned this fad will harm children through unnecessary medical treatment with permanent effect – sterilization for example, or the irreversible effect of testosterone on the growing female body.

In particular, a trend for transgender kids seems to target those children who do not conform to stereotypes society expects them to obey on account of their sex: who very often grow up to be wonderful, happy, effeminate gay men and butch lesbian or bisexual girls. We need years or decades to grow into ourselves as gay adults and the medicalization of difference through transgender seems like an attack on our personhood, an attack on our right to process being gay, painful and confusing and messy as it can be.

I have known dozens of gay men and lesbian women who might well have been “trans kids” today. Some of these gay men like to paint their nails, or dress up in women’s clothes (drag), and they care very much about clothing, and have some effeminate mannerisms. Some of these lesbians are rough and tough and they like short hair and clothing cut for men. They are happy and comfortable being who they are. I admire these non-conforming gay and lesbian people very much, because most never had the luxury of the closet, like I did. If they had been made into “trans kids” in order to produce humans who conformed better to a standard I think the world would be a poorer place and they would have been harmed. If the prevalent view of transgender is wrong then harm is being done to children and we cannot remain silent.

    I have also met transgender people, in real life and online, and I have listened to their pain over their “wrong bodies”. But I also do not understand how transgender can be destined or “real” in the same way that being gay is real. Transgender and gay are not interchangeable. There are profound differences between gay and transgender. The idea of transgender as a biologically destined, permanent, fixed identity should be justified on its own merits, not by a silencing tactic where activists claim their cause is no different from gay rights and scream “Transphobia” at all questions. Gay activists never had to silence, shame or threaten opponents, because our cause is just, cohesive and reasonable, and stands by itself.

    Nobody has ever shown being gay can be “cured” but there is evidence that transgender people do sometimes stop being transgender. People do detransition.  One way in which gay people have also argued against a notion that being gay was wrong was to point to gay animals. There are gay animals everywhere, and our closest ape relatives the bonobos are thoroughly homosexual, but mammals do not change sex. Nobody has ever seen a transgender sheep, where a ewe becomes a ram. A dominant female hyena can take on a male role but it is still a female that has a different, natural, hormonal balance, not a male hyena.

    Most importantly “the mind does not match the body” is the opposite of what being gay is about. At the end of our coming out stories, gay and lesbian people are comfortable being just who we are. There is nothing wrong with us, nothing wrong with the way we were born. Our problem is society’s prejudice, not our minds or bodies. Lesbian, gay and bisexual people have always demanded freedom from persecution and acceptance as the social and legal equals of straight people, which we are.

    There is no need for medical intervention, hormones and surgery to be gay. In fact the words transition and conversion are synonyms. There are alarming similarities between the discredited notion of conversion therapy against gay children and so-called gender transition therapy. Reinforcing this, conservative Islamic nations such as Iran, the United Arab Emirates, and Pakistan, all punish homosexuality, but encourage or mandate a conversion of gay men to transgender women via sexual reassignment. It is appalling to contemplate supposedly liberal parents replicating Iran-style erasure of gay people on their own children.

    Seen this way transgender could be compared to anorexia, because here too there is great unhappiness about the body. Anorexia is a real and serious condition, and anorexic people must have their human dignity respected, but it would be dangerous to say we should accept anorexia, or tell children anorexia was okay. Magazines that promote anorexic models and celebrities are criticized and there is an attempt to stop the fashion industry from doing this.

I probably would not have been a “trans kid” if I had grown up today. I was not effeminate but bookish and a science geek, and with the trend for medicalized childhoods, I might have been diagnosed with something else. There is a broader and long term trend of over-medicalizing children. A diagnosis like ADHD seems to often reflect an attempt to contain rambunctious childhood personalities. Of course medical treatment is not always bad but it must also be based on the best evidence that it is necessary and not harmful. What kind of evidence should we demand before assigning a child a medicalized identity, setting them down a road that can end in sexual reassignment?

I think parents and children should not always pursue instant gratification even if medicine seems to offer it.

Further reading

Human brains cannot be categorized into two distinct classes: male brain/female brain
There is probably no such thing as a ‘male’ and ‘female’ brain
Is there something unique about the transgender brain? These brain scans don’t reflect gender identity, they reflect sexual orientation.
New MRI studies support the Blanchard typology of male-to-female transsexualism
Ethical issues raised by the treatment of gender-variant prepubescent children: 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
Gender identity clinic for young people sees referrals double
Surge in demand sees one year waits for children’s transgender clinic
Child gender identity referrals show huge rise (930%) in six years
More U.S. hospitals offering gender affirming surgeries
Transgender kids: ‘Exploding’ number of children, parents seek clinical help
‘I was a boy.. then a girl.. now I want to be a boy again’: Agony of of teen who is Britain’s youngest sex-swap patient
Boy ‘living life entirely as a girl’ removed from mother’s care by judge
Mother of Transgender Toddler Gets a Lesson in Love
Clinics are popping up across the country to help kids as young as 3 who might be transgender
‘Thank God I didn’t have a sex change’: Gay actor Rupert Everett tells how he grew up wanting to be a girl but cautions against allowing children to make rash decisions on surgery
Furious parents slam ‘damaging’ BBC sex change show aimed at six-year-olds
100% blocker-to-HRC persistence rate in children
Transgender Youth: Are Puberty-Blocking Drugs An Appropriate Medical Intervention?
53% of mothers of boys with Gender Identity Disorder have Borderline Personality Disorder compared to only 6% of mothers of normal children
Female detransitioner survey
Female detransitioner speaks
Another teen goes from “I’m happy in my male body” to “I am truly a girl” in a few days.
Desistence of gender identity in children:
Do trans- kids stay trans- when they grow up? 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.
A New Way to Be Mad: Can the mere description of a condition make it contagious?
Why Some of the Worst Attacks on Social Science Have Come From Liberals
How did transgender get included in LGBT?
The attack on Germaine Greer shows identity politics has become a cult
Purplesagefem: Blatant homophobia