TOPIC UPDATES FOR 2023: TOPIC 1- DO CHILDREN & TEENS WITH SERIOUS GENDER DYSPHORIA EVER DESIST FROM THE DYSPHORIA. YES

Topic Updates for 2023: TOPIC 1 (Part 2)

Original Topic Post= 1) DO CHILDREN & TEENS WITH SERIOUS GENDER DYSPHORIA EVER DESIST FROM THE DYSPHORIA. YES

We are updating our Topics in 2023 with the most recent and relevant information regarding over-medicalized youth and identity confusion due to queer theory/gender ideology. Since the launch of our website in 2019, only more information has come to light validating our view that pediatric transition is dangerous for children and teens. We support honest and open inquiries regarding this topic. Our focus relates to protecting lesbian, gay, and bisexual youth from harm, and we want the best long-term health outcomes for all youth, regardless of identity or orientation.

One of the main reasons why LGB people are so concerned about the move to transition cognitively immature minors socially and medically is that they may desist from wanting to be the opposite sex or find less invasive ways to cope. Desistance/persistence research is very relevant to protecting LGB and other youth from the culture, parents, and health professionals tracking them into medical pathways they otherwise may avoid if given proper support and allowed to mature.

The increasing but unproven narrative in the “gender affirmative” movement is that no therapy can resolve gender dysphoria, and social and medical transition are the only options. Here is a case study where an individual resolved gender dysphoria with therapy by addressing homophobia, making this study pertinent to the concerns of GHQ:

Behavioral treatment of transsexualism: A case report:

Patients who believe themselves to be transsexual seek only confirmation of their diagnosis so that they may proceed with their pre-chosen course of management: hormones and surgery. Their syntonic emotional set generates resistance to any other therapeutic direction. Despite this attitude, it is the therapist's responsibility to assess each case individually and to decide, with the patient, on realistic goals even if they be different from the original one. This case emphasizes this need since a probing history revealed underlying conflict and anxiety related to severe homophobia. With revelation of the homophobia, various behavioral techniques could be used therapeutically. These resulted in acceptance of lesbianism as a life style. Careful assessment of patients with self-diagnoses of transsexualism can sometimes uncover a different etiology to which appropriate therapy can be applied.

There is a critical study, Singh et al. (2021), called A Follow-Up Study of Boys With Gender Identity Disorder. It shows high rates of desistance in boys with DSM-diagnosed gender dysphoria. Many desisters grew up to be gay men, as indicated in previous studies. The results- 139 participants, 17 (12.2%) were persisters, and the remaining 122 (87.8%) were desisters. This is a very high rate of desistance from a clinical diagnosis, thus involving some amount of distress. These were not just “boys who liked pink.”

It appears persisters on average will be the most “gender variant,” which is not surprising:

Compared to the reference group, the biphilic/androphilic persisters tended to be older at the time of the assessment in childhood, were from a lower social class background, and, on a dimensional composite of sex-typed behavior in childhood were more gender-variant. The biphilic/androphilic desisters were more gender-variant compared to the gynephilic desisters. Boys clinic-referred for gender identity concerns in childhood had a high rate of desistance and a high rate of a biphilic/androphilic sexual orientation. The implications of the data for current models of care for the treatment of gender dysphoria in children are discussed.

But this doesn't mean no desisters fell into this range, given these are averages. In fact, many did. There was more detailed information in the dissertation by Devita Singh that was the basis for this paper. One measure of particular interest was a composite score of each subject's scores on several tests that may indicate more intense levels of dysphoria or gender nonconformity:

As can be seen from Table 15, the childhood sex-typed behavior measures on which the groups differed were significantly correlated.24 From these six measures (first drawn person on the Draw-a-Person, free play, Gender Identity Interview, cross-sex peer preference on the Playmate and Play Style Preferences Structured Interview, 21 cross-sex toy preference on the Playmate and Play Style Preferences Structured Interview, and the Gender Identity Questionnaire for Children), a composite score of childhood sex-typed behavior was derived for each participant by taking the average of the six variables 25 (each expressed as z-scores). Thus, the composite score was expressed as a z-score. A higher composite z-score indicates more cross-gender behavior at assessment (Fig. 2).

 We see that the differences between the Draw-a-Person test, was not significantly different between the persisters and homosexual desisters:

On the Draw-a-Person, there was one significant post-hoc contrast. The bisexual/ homosexual persisters were, on average, significantly more likely to draw a female first compared to the heterosexual desisters (p = .04). The comparison between the bisexual/ homosexual desisters and heterosexual desisters approached significance (p = .09), with the bisexual/homosexual desisters showing a greater tendency to draw a female first. The comparison between the bisexual/homosexual persisters and bisexual/homosexual desisters was not significant (p > .05)

Also:

The bisexual/homosexual persisters had a 274% increase in odds of having a higher composite score (i.e., more childhood cross-gender behavior)…

 And regarding desisters:

The bisexual/homosexual desisters had a 48% increase in odds of having a higher composite score compared to the heterosexual desisters.

We see that a significant number of homosexual desisters, a larger group than the persisters (N=66 v n=16), fell into the range of the persisters’ z-score. This is the population Gender Health Query is most concerned about, very gender nonconforming and cross-sex identified boy children, who now will be reinforced in body dissociation and possibly medicalized at puberty before testosterone exposure to their brains during the maturation process.

The paper discovers the most relevant variables, as seen below. Interestingly, lower socioeconomic status increases the likelihood of persistence, and they suggest these families may be more likely to have negative views of homosexuality and prefer a trans status in their child.

To evaluate the influence of childhood sex-typed behavior and demographic variables on group outcome at follow-up, a multinomial logistic regression was performed using the composite score and the demographic variables on which the groups differed26–age at assessment, IQ, and social class–as predictor variables. It can be seen from Table 16 that both social class and the composite score of childhood sex-typed behavior were significant predictors of group outcome at follow-up in the first model which compared the bisexual/ homosexual persisters to the bisexual/homosexual desisters

Dr. Ken Zucker stated on his twitter account the study has flaws but:

I think that this is the best follow-up study to date in terms of the sample size and the methods of assessment. It does, of course, have its flaws, but I think that the data speak for themselves.

See the entire thread here https://threadreaderapp.com/thread/1376412138227503104.html

 Zucker notes in a tweet thread:

This will probably be the last follow-up study in the literature that tracks longer-term psychosexual development of children (i.e., those seen clinically for the first time between the ages of 3-12 years) during an era where "treatment"--when there was treatment--came in a...

variety of shapes and forms. But the one type of "treatment" (with one exception) that these children did not receive was what is now known as pre-pubertal social transition. Thus, this follow-up study can be used as a comparative benchmark with regard to the persistence and...

desistance of gender dysphoria for any new follow-up studies that look at persistence and desistance among children who socially transitioned prior to puberty. I have argued elsewhere (Zucker, 2018) and in the Discussion that pre-pubertal social transition (where it is...

implemented by parents, on their own, without any clinical input from "professionals" or at the suggestion of professionals, or in combination is a form of psychosocial treatment of gender dysphoria...just of a very different kind.

We did internet searches to see if any “LGBTQ” organizations such as the HRC, PFLAG, or The Trevor Project referenced this study, given they are recommending social and medical transition of children and teens. They have not, to our knowledge. We believe these entities have become a danger to pre-gay and lesbian youth despite putting LBG in their names. Their purpose is exclusively promoting the interests of current trans activism, medicalizing children/teens, and replacing sex-based rights in law with gender identity.

The high desistance rate in the above study that took place at a time when they were not being "affirmed" is in stark contrast to an extremely high persistence rate in a follow-up study by The Trans Youth Project regarding fully "affirmed" minors called “Gender Identity 5 Years After Social Transition.”

RESULTS
We found that an average of 5 years after their initial social transition, 7.3% of youth had retransitioned at least once. At the end of this period, most youth identified as binary transgender youth (94%), including 1.3% who retransitioned to another identity before returning to their binary transgender identity. A total of 2.5% of youth identified as cisgender and 3.5% as nonbinary. Later cisgender identities were more common among youth whose initial social transition occurred before age 6 years; their retransitions often occurred before age 10 years.

This paper will be discussed in more detail in an update to Topic 4 due to their avoidance of contemplating that they are tracking would-be desisters into trans identities, and that this could account for their drastically higher persistence rates versus prior studies.

The same group of researchers published a paper called Retransitioning: The experiences of youth who socially transition genders more than once that focused on the youth who keister from a cross-sex identity. Their use of the term “retransition” is the new preferred parlance of affirmative model advocates.

They state:

Conclusions: These findings largely do not support common concerns about retransitions. In supportive environments, gender diverse youth can retransition without experiencing rejection, distress, and regret.

This comment lends no proof one way or the other that the affirmative protocol is or isn’t significantly increasing the likelihood that youths will medicalize.

The study Progression of Gender Dysphoria in Children and Adolescents: A Longitudinal Study tracked youth from an insurance database:

METHODS
A cohort of 958 gender-diverse (GD) children and adolescents who did not have a gender dysphoria–related diagnosis (GDRD) or GAHT at index were identified. Rates of first GDRD and first GAHT prescription were compared across demographic groups.

And:

The STRONG cohort includes participants from Kaiser Permanente (KP) integrated health care systems in Georgia, Northern California, and Southern California.

They found that some youth with gender dysphoria diagnosis were not dysphoric post puberty. It also appears females may be less likely to desist than males:

Both Dutch studies found that most participants did not experience gender dysphoria beyond puberty. This result is consistent with our observation that less than one-third of children presenting with GD behaviors received a GDRD and only approximately one-quarter initiated hormone therapy during follow-up. The Dutch researchers also reported a greater likelihood of unalleviated gender dysphoria in children who presented at an older age and among AFAB participants, both results in agreement with our findings.

A study, Karrington (2022), published by a trans-identified individual in Transgender Health, is called “Defining Desistance: Exploring Desistance in Transgender and Gender Expansive Youth Through Systematic Literature Review.” It claims that desistance isn’t a relevant concept for study. Desistance in the paper is defined below:

Thirty definitions of desistance were found, with four overarching trends: desistance as the disappearance of gender dysphoria (GD) after puberty, a change in gender identity from TGE to cisgender, the disappearance of distress, and the disappearance of the desire for medical intervention.

The conclusion of the paper obviously advocates for the affirmative model trans activists are demanding. Not bothering with tracking social and medical influences on persistence/desistance serves their priorities:

Conclusions: This review demonstrates the dearth of high-quality hypothesis-driven research that currently exists and suggests that desistance should no longer be used in clinical work or research. This transition can help future research move away from attempting to predict gender outcomes and instead focus on helping reduce distress from GD in TGE children.

Another trans activist produced a similar paper, Ashley (2022), called “The Clinical Irrelevance of “Desistance” Research for Transgender and Gender Creative Youth.”

Lisa Selin Davis, who has been writing on this subject, discussed desistance research in an article for Skeptic called “Trans Matters: An Overview of the Debate, Research, and Policies.”

She also reported on an individual case of desistance in an article titled “A Desister’s Tale.” The article concludes:

Children and their families should know about the desistance literature, and that the way they feel now, no matter how intensely, isn’t necessarily a sign of how they’ll feel in the future. By exposing them to a diversity of stories, including Ash’s, we can restore balance to the discussion in a way that may help many distressed young people navigate a difficult and confusing time.

Individual cases of desistance are also in “’Desistance’ in two cases of transgender men” on Why Evolution is True.

Despite the existence of desistance, WPATH is removing any recommendation for age restrictions on medicalizing minors.

Elkadi et al. (2023), a paper called “Developmental Pathway Choices of Young People Presenting to a Gender Service with Gender Distress: A Prospective Follow-Up Study,” discusses desistance rates:

This prospective case-cohort study examines the developmental pathway choices of 79 young people (13.25–23.75 years old; 33 biological males and 46 biological females) referred to a tertiary care hospital’s Department of Psychological Medicine (December 2013–November 2018, at ages 8.42–15.92 years) for diagnostic assessment for gender dysphoria (GD) and for potential gender-affirming medical interventions. All of the young people had attended a screening medical assessment (including puberty staging) by paediatricians. The Psychological Medicine assessment (individual and family) yielded a formal DSM-5 diagnosis of GD in 66 of the young people. Of the 13 not meeting DSM-5 criteria, two obtained a GD diagnosis at a later time. This yielded 68 young people (68/79; 86.1%) with formal diagnoses of GD who were potentially eligible for gender-affirming medical interventions and 11 young people (11/79; 13.9%) who were not. Follow-up took place between November 2022 and January 2023. Within the GD subgroup (n = 68) (with two lost to follow-up), six had desisted (desistance rate of 9.1%; 6/66), and 60 had persisted on a GD (transgender) pathway (persistence rate of 90.9%; 60/66). Within the cohort as a whole (with two lost to follow-up), the overall persistence rate was 77.9% (60/77), and overall desistance rate for gender-related distress was 22.1% (17/77). Ongoing mental health concerns were reported by 44/50 (88.0%), and educational/occupational outcomes varied widely. The study highlights the importance of careful screening, comprehensive biopsychosocial (including family) assessment, and holistic therapeutic support. Even in highly screened samples of children and adolescents seeking a GD diagnosis and gender-affirming medical care, outcome pathways follow a diverse range of possibilities.

This abstract confirms DSM diagnosed minors do desist from the clinical definitions of gender dysphoria as listed in the “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition” which is supposed to have more rigid criteria, reducing the likelihood of defining desisters as “true trans.” The desistance rate is still low compared to prior studies where children were not affirmed in their gender dysphoria and cross-sex identification which is concerning. We can also see two of the minors who didn’t receive an initial DSM diagnoses, wound up with one later. The affirmation of gender dysphoria in youth with forming identities is a severe risk to these minors as transition regret appears to be increasing.

Topic 8 deals with detransition and regret. One can find many examples are LGB youth.

See Original Post 1) DO CHILDREN & TEENS WITH SERIOUS GENDER DYSPHORIA EVER DESIST FROM THE DYSPHORIA. YES

More blog posts relating to this Topic are here.

CONTINUE TO TOPIC 2:

Hormone blockers, trans youth, & permanent side effects such as sterility & loss of sexual function
Medical consequences of hormone blockers, cross-sex hormones, surgery, to gender dysphoric & trans youth

Stats for Gender: A New Resource for Accurate Information Regarding Gender Dysphoria

News Commentary

Stats for Gender (statsforgender.org) is an organization that has formed recently to provide people with legitimate resources regarding gender dysphoria. There is a lot of misinformation and spin in the press regarding gender dysphoric youth and the trans movement in general. This also extends to medical bodies that fail to describe gender dysphoria research accurately. This is particularly true in regards to desistance and suicide risk. Stats for Gender will be a good resource for those seeking accurate information. GHQ does it’s best to source our material and examine data in legitimate ways regarding gender dysphoria research. References can be found in links at the end of each “Topic.”

WPATH Requests Public Comments for SOC8 Guidelines

News Commentary

WPATH (World Professional Association for Transgender Health) is an organization that creates “standards of care” for transgender individuals. They are requesting public comments. There were many issues with the wording of this document (we hoped to post a write-up later). We chose to focus our comments on their lack of acknowledgment that LGB people may experience transient gender dysphoria while they are children, teens, or young adults. They can be found below:

Childhood GD

Gender Health Query submitted comments as an organization expressing our concerns under the adolescent section. We request WPATH clearly state gay, lesbian, and bisexual youth experience transient childhood (and increasingly transient teen/YA onset) gender dysphoria. The growing numbers of LGB young people expressing transition regret or telling stories of near misses with hormone use or underage surgeries before they desisted represent a significant human rights issue for LGB populations. The avoidance of discussion about GD and gay and lesbian identity throughout these sections is odd, given the research on desistance and adult gay and lesbian identity is very robust. A review of the data from these studies, Drummond et al (2008), Wallien and Cohen-Kettenis (2008), Singh (2012) and Steensma et al (2013), demonstrate a 67% desistance rate average for DSM-diagnosis-positive youth. Many of these desisters grew up to be same-sex attracted, and not medicalizing them at a young age was critical to their human rights and natural development. 

Why is WPATH engaging in this type of avoidance of discussion of gay and lesbian identity? We would like to see evidence of your concern about these youths in these guidelines. The number of detrans same-sex attracted youth appears to be growing. 

Thank you for your time and request for feedback.

Adolescent GD

As is the case with the child section, WPATH avoids mentioning the risk of pediatric medical transition to gay, lesbian, and bisexual youth who may experience intense but transient gender dysphoria while growing up into adulthood. The risks of pediatric transition to them are not theoretical. We are indeed seeing disturbing numbers of damaged young people who come to realize they were just LGB when their brains mature into adulthood, and they realize that transition was a mistake. This is the same thing that happened in Thailand when gay rights activists were receiving complaints from many very young gay men with medical transition regret:

 https://www.telegraph.co.uk/expat/expatnews/6669101/Thailand-tightens-sex-change-laws.html

We expect worse consequences here in the US given youth are being medicalized at even younger ages than in Thailand and on a much larger scale. This is an easily predictable outcome given prior research on desistance and adult gay and lesbian identity:

Drummond et al (2008)
Wallien and Cohen-Kettenis (2008)
Singh (2012)
Steensma et al (2013) 

The current affirmative model is essentially designed to maximize persistence and medicalization and minimize youth going through the developmental process and struggles of growing into an adult gay or lesbian identity. Also, bisexual females now are particularly experiencing an explosion in trans identification while dealing with the difficulties of puberty. There isn't always clear line between trans and LGB in young people. This should be clearly stated in WPATH documents if you want to be seen as caring about these young people and the implications pediatric transition has for LGB populations. For example, you should admit homophobic bullying increases the likelihood of trans-identification, strongly indicating GD is not only an innate identity but influenced by social forces, and bullying and hatred of gay and lesbian people specifically:

https://www.docdroid.net/kWO8DNY/the-influence-of-peers-during-adolescence-does-homophobic-name-calling-by-peers-change-gender-identity-pdf

There is a growing number of homosexual and bisexual people who are aware that gender clinics are damaging LGB youth. We believe that WPATH's avoidance of clearly stating that pre-gay and lesbian children and LGB youth may experience gender dysphoria that may resolve with time is intentional, so these potential desister/detrans youths do not become roadblocks to pediatric medicalization. This has severe consequences for LGB communities that are very small and are now coping with traumatized youth with irrevocably altered bodies and who have no resources. Please state that LGB youth specifically experience gender dysphoria and that this is also an LGB human rights issue regarding proper mental health care and the right not to be over-medicalized as a cognitively immature young person by gender clinicians such as yourselves. 

Thank you for your time

Gender Dysphoria Endocrine Society & Pediatric Endocrine Society Guidelines Intentionally Hide Risk & Harm

Editorial

Heading: “Your Dangerous, Inaccurate, and Ideological Guidelines for Trans-Identified Youth”

Sending this to 100s of mental health and medical professionals as this is a wide-spread problem- apathy about risk to LGB and other youth. This is profoundly destructive to these individuals and to our communities. The younger children are transitioned, the more of them there will be.

To the Endocrine Society and Pediatric Endocrine Society,

We are board members for an LGBT medical watchdog organization regarding pediatric medical transition for minors with gender dysphoria. In 6 years of intensely researching this issue, your recent statements and guidelines on this topic are some of the most unethical and sloppy of anything we have seen, in our free-speech opinion. And we have seen a lot of substandard discourse, confirmation bias, censorship, and blatant disregard for the safety of mostly LGB youth who may resolve GD as all prior research shows many do. There are so many ideological spins and factual errors in these documents it would take far too long to go over them all. And that should not be the public’s job. That is your job as the leadership and board members of The Pediatric Endocrine Society and the Endocrine Society, tasked with the most important goal of all, being trustworthy. Your organizations are experiencing ideological capture by extremist gender identity activists (even PhDs and MDs), and our guess is that you are entrusting small, agenda-driven committees to write balanced information. This is a huge mistake regarding this contentious and complicated issue that requires responsible nuance.

No, the “affirmative model” is not universally recognized as “safe” by all gender dysphoria experts, and it is clearly proving to be unsafe for some young people. That is the truth.

BBC

FB comment from WPATH member

Science bodies have a moral obligation to present facts and accurate information to the doctors and scientists they represent and the public. If you don’t, you will justifiably be accused of negligence and malpractice for the harm we are seeing befall young people due to the dishonesties represented in your documents regarding gender dysphoric youth. These dishonesties are being exposed by a groundswell of well-informed parents, doctors, mental health professionals, trans-rationalists, detransitioners, podcasters, and concerned LGB people who have been going public for years, negating the possibility of plausible deniability by organizations such as yours. 

The documents in question: 

https://transhealthproject.org/resources/medical-organization-statements/endocrine-society-statements/

https://www.endocrine.org/-/media/a65106b6ae7f4d2394a1ebeba458591d.ashx

https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaa816/6031005

https://www.endocrine.org/-/media/endocrine/files/advocacy/position-statement/transgender_health_minors_fact_sheet.pdf

And here is this statement demonstrating the Endocrine Society and Pediatric Endocrine Society have a complete lack of concern or compassion for the young woman in the Bell v Tavistock case (she won) who transitioned at too young an age who is now permanently scarred by doctors such as yourselves. She is here merely as a prop to be kicked to the side and aggressively opposed so you can continue to prescribe extreme and experimental medical treatments on minors who don’t reach full executive function until age 25:

https://www.eurekalert.org/pub_releases/2020-12/tes-dpt121120.php

While there are too many errors and hard ideological slants to go over in the material in these links, we will review a few of the most egregious. This is unacceptable for doctors’ organizations.

Your attempt to debunk this quote falls flat to those of us who know what is really going on:

“Texas should ban chemical castration, puberty blockers, cross-sex hormones and genital mutilation surgery on all minor children for transition purposes, given that Texas children as young as three (3) are being transitioned from their biological sex to the opposite sex.” Even though “chemical castration” and “genital mutilation” are not part of gender-affirming care for minors, such wording serves to alarm the general public, and 94.57% of the electors supported the measure [15].

Not part of gender-affirming care for minors? While you may dislike the phrase “chemical castration” because it doesn’t have the marketable ring of “gender affirming” it is the proper term for the use of hormone blockers. These are the very drugs and terminology used to “chemically castrate” sex offenders. When you give puberty blockers to an 11-year-old, you stunt their genital growth. The problem of “micropenis” is well documented and the state becomes permanent when the youth goes on estrogen. This can permanently destroy the youth’s sexual response making a fully realized adult romantic relationship impossible. Due to lack of tissue, the youth now requires a rectosigmoid or peritoneal graph vaginoplasty to create a neovaginal canal as surgeons can’t do the “gold standard” one. These protocols sterilize both sexes. The wording in the quote above is hardly hyperbolic.

And now to the second part of the inaccuracy of the sentence. Genital surgeries are done on minors. Jazz Jennings, who likely has permanently destroyed sexual function for life, had this procedure done at 17 on national television. Jazz had to have 3 corrective surgeries after the experimental vaginoplasty “popped” and collapsed, an incident described by Jazz as extremely messy and painful. This path was decided by Jazz at age 11 when doctors such as yourselves prescribed hormone blockers. One of the patients in the Steensma/de Vries cohort died from the vaginoplasty, despite this being the #1 “success” study cited to promote pediatric transition. These young people are guinea pigs. We contest a child who hasn’t had a first boyfriend or crush even, can consent to permanent sexuality destruction despite your confidence in the face of conflicting data and views. There are trans people who adamantly oppose this.

Should the public feel “alarm” over this?

Reddit

Here is evidence of vaginoplasty surgeries underage. The same is true for double mastectomies performed on tweens.

https://www.prweb.com/releases/2014/09/prweb12141694.htm:

“The patient, a California high school student who began administering estrogen and anti-androgens to transition from male to female at the age of 11, is the youngest transgender patient in U.S. history to completely avoid male puberty and subsequently undergo gender reassignment surgery at the age of 16.”

Another problem:

"Gender identity was considered malleable and subject to external influences. Today, however, this attitude is no longer considered valid."

A detransition subreddit with thousands of people holds views that say otherwise. We also document many social factors that influence gender dysphoria linked below. Of particular concern to us, but not you, is that homophobic bullying pushes youth towards trans identification. This is according to a peer-reviewed study and many anecdotal examples of LGB youth who claimed this was the case or their therapists saying so. Lack of stability in the home appears to be another environmental factor. There are many examples of social contagions throughout history, and most involve young females. We believe there is robust evidence to support this is currently the case with spiking levels of trans identification in females. Responsible doctors analyze situations when epidemiology has drastically changed. 

We are an intellectually honest, evidence-based organization. We cover the valid "nature" data on brain research, lending credence to the above claim's possibility. But why does a layperson org have more comprehensive, evidence-based information than the Endocrine Society or Pediatric Endocrine Society? You pretend people who flatly state their social environment helped fuel their dysphoria and desire to transition don't exist. You pretend the multiple sex and gender researchers who worry that early social transitions may groom pre gay and lesbian children for medicalization don’t exist (Dr. Wren, Dr. Carmichael, Dr. Cantor, Dr. Zucker, Dr. Soh, Dr. Bailey, Dr. Blanchard, Dr. Korte, Dr. Drescher, Dr, Bradley, even Dr. Steensma have made these statements). The very design of your materials is to hide harm and risk. This is intentional, isn’t it? To see yourselves as protecting the important children even if it means recklessly endangering others by pretending they don’t exist, and ensuring your doctors and the public don’t know they exist.

https://www.genderhq.org/trans-nature-vs-nurture-innate-gender-identity-culture

https://www.genderhq.org/increase-trans-females-nonbinary-dysphoria 

https://www.genderhq.org/trans-children-gender-dysphoria-desistance-gay/#anchor-page1-section-b

You cite Jack Turban and pretend serious critiques by GD experts of his work don't exist. A good list of these professionals can be found in the comments on his JAMA article (under paywall), which should have been published if people were acting with integrity around this issue. 

https://www.genderhq.org/blog/conversion-therapy-trans-study-turban?rq=Turban

https://www.genderhq.org/blog/2020/11/2/recent-article-criticizes-the-quality-of-jack-turbans-analysis?rq=Turban

Miesen (2018)

Another criticism: 

https://pubmed.ncbi.nlm.nih.gov/30392631/

“We work and live with the co-occurrence of autism and gender diversity on a daily basis, and we are concerned that perpetuating misunderstanding about the co-occurrence places individuals at risk.”

More on Jack Turban: 

http://link.springer.com/10.1007/s10508-020-01844-2

Moving on:

“Pre-pubertal youth who are supported and affirmed in their social transition long before medical interventions are indicated, experience no elevation in depression compared to their cis-gender peers.” (12)

Your reference is Achilles (2020). Should this not be Olson (2016)? Achilles is a drug study on adolescents. And the social transition Olson study is far from perfect.

Here is another example of the malpractice of your documents that violate all standards of informed consent:

"Over the last decade, there has been considerable research on and development of evidence-based standards of care that have proven to be both safe and efficacious for the treatment of gender dysphoria/gender incongruence in youth and adults.”

Where is this hard evidence this is “proven” “safe?” Jazz Jennings had 4 sexuality-destroying vaginoplasty corrective surgeries and will never have any sexual feeling, and you call this “safe.” Multiple gender dysphoria experts are concerned about this harming potential desisters, and you call this “safe.” There is information that this impacts bone health, and you call this “safe.” It looks like the blockers you are prescribing cognitively immature children can negatively impact pubertal brain development by lowering IQ. IQ is something very pertinent to career choice and earned income. But this is “safe.” There is no mention of the study that indicates a significant increased risk of heart attack in FtMs or mitochondrial damage or vaginal atrophy. You don’t mention you have no idea what the long-term consequences are of transitioning tweens on their bodies over the decades to come. How is this ethical, this hiding by you of negative, valid data? How? Having a good, honest desire to help this population is not a valid excuse for violating basic tenants of informed consent and “do no harm.” Citations for serious medical side-effects below:

https://www.genderhq.org/trans-youth-side-effects-hormone-blockers-surgery

We highly recommend you look at historical accounts of how medical and mental health professionals have harmed the public due to mirthful excitement about new protocols that wound up harming people because sterilizing children, destroying their sexual response forever, harming LGB youth, impacting bone health, IQ, and circulatory health are grave matters. We aren’t lawyers, but it sounds like “safe” is lawsuit-worthy (and was in the Bell v Tavistock case).

Bottom line- The sheer extremity of what you are doing to children is because you are being led to believe you are preventing suicides (referenced in your documents). There is a lack of robust proof that this is true, and several media-covered suicides used to promote underage transition involved fully affirmed youth with access to medical protocols. Inflating suicide risk, something often employed by affirmative model doctors and therapists to the public, violates all anti-suicide reporting guidelines, even those for LGBT youth laid out specifically by the American Foundation for the Prevention of Suicide. Suicide is highly socially contagious. Sending the message youth will kill themselves if not given strong drugs immediately is harmful. GHQ does not spin suicide. It is too serious a matter. No one should. Some studies indicate transition is helpful in this way. The studies in the Cornell review and others that have this information is on our evidence-based website.

But we will list studies/articles that should alarm you given the soaring numbers of children endocrinologists are “chemically castrating,” leading to underage surgeries: 

Branstrom (2020) recently had to be corrected (authors really wanted positive results). The reality is this study from Sweden’s healthcare system, with a large population, failed to prove mental health benefits to either hormonal therapy or sex reassignment surgery. This is in a country that is very pro LGBT, where people have access to public healthcare. It’s not perfect data but better than much in the Cornell review.

Lipson (2019) should concern you. This is a large population of college students surveyed. Why is the mental health so poor in trans people at universities where trans identity is celebrated, minority status is elevated in general, and they have access to student health care that often pays for transition?

Graph circulated by a researcher on SM regarding Lipson (2019)

The use of puberty blockers has not been shown to improve mental health in the UK, one of the reasons Tavistock lost the Bell v Tavistock case. There are likely thousands of kids on these blockers now in the US.

http://users.ox.ac.uk/~sfos0060/Biggs_ExperimentPubertyBlockers.pdf?fbclid=IwAR2X8HdzFfeUnaY0995EiTh9-gYCBKz5FmHG98PTdMjbXgZd5IhhGvl6uhY

At this time there are 20,000 adverse effects reported to the FDA from Lupron. An older article-

https://khn.org/news/women-fear-drug-they-used-to-halt-puberty-led-to-health-problems/

See Adams (2017)- This study, a meta-synthesis analysis, indicates transition may be ineffective in reducing suicide risk. When combining averages across 42 of the more recent studies (relevant because being trans was likely more difficult and unaccepted in the past), they found very high suicide ideation rates, even within the last year. Past year's stats also are not much better than lifetime stats in this review. And these are individuals accessing "gender-affirming" medical care. 

Stop engaging in desistance denial. This data is not presented in your documents. Having researched this for years, we understand why. Desistance data clearly shows pediatric transition is a risk to pre-gay and lesbian kids and ROGD (Littman 2018) shows this is a risk to teens struggling with puberty. This isn't included because you do not care about these youths. No one does in “affirmative” discourse. If you cared, you would address the risks to them and their needs. You can see it every time any data or evidence shows they are being harmed (they are) or may be harmed. You can see a long list of censorship incidences enforced not only by activists (who always threaten people) but by major universities, LGBT media, and magazines like Psychology Today. Everyone does it who wants to appear "progressive." Because LGB youth don’t matter. Girls struggling with puberty don’t matter. Girls who may have a sexual assault in their background don’t matter. If they mattered, you would talk about their needs and suffering, how they are scarred when their body parts are removed at too young an age, and how you are destroying their human right to just grow up and work out their identity issues.

You can't bring yourselves to write one sentence in care of them. Not one.

http://www.heather-brunskell-evans.co.uk/body-politics/1114/

There is so much that is sloppy about your material and ignoring of legitimate studies and critiques of the happy/safe narrative. Please fix this. It delegitimizes you and violates your moral and professional obligations. There are too many people who are very well informed who will hold those accountable for ignoring risk and, worse, lying about it and covering it up. We will leave by summarizing the problems:

1) No acknowledgment of high rates of desistance in all prior research and the likelihood of them being gay or lesbian, thus obscuring risk to pre-gay kids by putting them in social transition at age 5 and interfering with their natural puberty with blockers.

2) No acknowledgment of bizarre trends of clusters of teenage females coming out as trans in a gender dysphoria spike unheard of 20 years ago. Any responsible health professional takes a close look at a condition when its epidemiology changes drastically, especially when treatment results in permanently altering a minor and social contagion is a well-established phenomenon with many historical examples.

3) No acknowledgment of several disturbing studies indicating the hormone blockers, hormones and sex reassignment surgery overall may not reduce the likelihood of mental health problems and suicide risk. And no honest review of information showing very significant negative health impacts.

4) References to Jack Turban and no references to the critiques of this barely out of med school doctor’s work. 

5) No care from the Endocrine Society and Pediatric Endocrine Society for mounting numbers of mostly young women, many ASD and/or lesbian and bisexual, encouraged to hate their bodies as struggling same-sex attracted tomboys, who are now permanently scarred by the mental health and medical profession. See their stories on this subreddit with thousands (assume a high 90% are lurkers and just 10% detrans/desisters, this is a lot of people with regret on this site with 17K subscribers).

https://www.reddit.com/r/detrans/

Tout data that shows benefits to pediatric transition. It’s there. We don’t deny that. But this is an unfolding nightmare and major human rights violation for those of us who care about pre-gay and lesbian kids and LGB teenagers, known to experience intense but ultimately transient GD. We are also very small minority groups. More and more detransitioned young people are significantly impacted. Our communities and our humanity are significantly impacted. We do not blame the mounting numbers of scarred and permanently altered young people. We are working to ensure mental health and medical professionals involved in these inappropriate transitions are held accountable and are not allowed to kick these “bad optics” youth under the rug as morally acceptable collateral damage. Your endocrine guidelines/statements do just that and it’s intentional.

We are a trans-inclusive organization that cares about the obsession with passing being worshipped over brain development, bone health, genital development, avoiding severe and experimental bottom surgeries, and fertility.

This will be on our website. We will provide documentation of this to anyone who later feels they were harmed by the doctors in your organizations following substandard informational guidelines and want them held accountable. This has been successfully done in the UK. Don’t assume there isn’t an intense motivation to hold those accountable in the US. Don’t assume you are immune.

We aren’t the only people/organization/group concerned about this international issue. And some of them are trans.

https://segm.org

https://rethinkime.org

https://detranscanada.com

https://www.gccan.org

https://lgballiance.org.uk (with chapters in the US, Canada, Poland, and Australia)

https://www.transgendertrend.com

Supporting parents of children with gender dysphoria

https://genderreport.ca

_____________________________________

Our board

https://www.genderhq.org/about

A list of supporters

https://www.genderhq.org/letter-signatures 

References:

Adams, N., Hitomi, M., & Moody, C. (2017). Varied Reports of Adult Transgender Suicidality: Synthesizing and Describing the Peer-Reviewed and Gray Literature. Transgender Health, 2(1), 60-75. doi:10.1089/trgh.2016.0036

Holt, A. (2020, December 1). Puberty blockers: Under-16s 'unlikely to be able to give informed consent.' BBC. Retrieved from https://www.bbc.com/news/uk-england-cambridgeshire-55144148

Correction to Bränström and Pachankis. (2020, August). The American Journal of Psychiatry. Retrieved from https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.1778correction

Biggs, M. (2019, July 29). The Tavistock’s Experiment with Puberty Blockers. Retrieved from http://users.ox.ac.uk/~sfos0060/Biggs_ExperimentPubertyBlockers.pdf?fbclid=IwAR2X8HdzFfeUnaY0995EiTh9-gYCBKz5FmHG98PTdMjbXgZd5IhhGvl6uhY

Brunskill-Evans, M. (2018, June 21). A Woman’s Place is Standing Her Ground. Retrieved from http://www.heather-brunskell-evans.co.uk/body-politics/1114/

D’Angelo, R., Syrulnik, E., Ayad, S, Marchiano, L., Kenny, D.T., Clarke, P. One Size Does Not Fit All: In Support of Psychotherapy for Gender Dysphoria. Archives of Sex Behavior (2020). Retrieved from https://doi.org/10.1007/s10508-020-01844-2

Endocrine Society (2020, December 16). Discriminatory policies threaten care for transgender, gender diverse individuals. EurekAlert. Retrieved from https://www.eurekalert.org/pub_releases/2020-12/tes-dpt121120.php

Endocrine Society, Pediatric Endocrine Society. Transgender Health: Suporting Gender Diverse Youth to Improve their Health, Well-being, And Safety. Retrieved from https://www.endocrine.org/-/media/endocrine/files/advocacy/position-statement/transgender_health_minors_fact_sheet.pdf

Endocrine Society, Pediatric Endocrine Society. Endocrine Society and Pediatric Endocrine Society Transgender Health Position & Statement (2020). Retrieved from https://www.endocrine.org/-/media/a65106b6ae7f4d2394a1ebeba458591d.ashx

Endocrine Society (2020, December 16). Discriminatory policies threaten care for transgender, gender diverse individuals. EurekAlert. Retrieved from https://www.eurekalert.org/pub_releases/2020-12/tes-dpt121120.php

Jewett, C., & Kaiser Health News. (2017, November 30). Women Fear Drug They Used To Halt Puberty Led To Health Problems. Retrieved from https://khn.org/news/women-fear-drug-they-used-to-halt-puberty-led-to-health-problems/

Lipson, S.K, Raifman, J., Abelson, S., Reisner, S.L. Gender Minority Mental Health in the U.S.: Results of a National Survey on College Campuses. American Journal of Preventative Medicine 53(3), 293–301. doi.org/10.1016/j.amepre.2019.04.025

Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3), e20153223. doi:10.1542/peds.2015-3223

PRWeb. (2014, September 5). Beverly Hills Plastic Surgeon, Gary Alter, MD, Performs Gender Reassignment Surgery on Youngest Transsexual Patient in the United States. Retrieved from http://www.prweb.com/releases/2014/09/prweb12141694.htm

Strang, J.F., Janssen, A., Tishelman, A., Leibowitz, S.F., Kenworthy L, McGuire, J.K., Edwards-Leeper, L., Mazefsky, C.A., Rofey D., et al. (2018) Revisiting the Link: Evidence of the Rates of Autism in Studies of Gender Diverse Individuals. Journal of the American Academy of Child & Adolescent Psychiatry 57(11), 885-887. doi: 10.1016/j.jaac.2018.04.023

TLDEF's Trans Health Project (2020, December 17). Endocrine Society. Retrieved from https://transhealthproject.org/resources/medical-organization-statements/endocrine-society-statements/

van der Miesen, A., Cohen-Kettenis, P., de Vries, A. (2018) Is There a Link Between Gender Dysphoria and Autism Spectrum Disorder? Journal of the American Academy of Child & Adolescent Psychiatry 57(11), 884-885. doi:https://doi.org/10.1016/j.jaac.2018.04.022

Walch, A., Davidge-Pitts, C., Safer, J.D., Lopez, X., Tangpricha, V. Iwamoto, S.J. (2020, December 16). Proper Care of Transgender and Gender Diverse Persons in the Setting of Proposed Discrimination: A Policy Perspective. The Journal of Clinical Endocrinology & Metabolism. doi.org/10.1210/clinem/dgaa816

GHQ Responds to the American Psychological Association Guideline for TGNC People

News Commentary

This is our response to a request for feedback from the public regarding the APA’s guidelines for trans and nonbinary-identified people. A complete copy of “Guidelines for Psychological Practice With Transgender and Gender Nonconforming People” can be found here and comments are received until 9/30/20:

Guideline 1. “Psychologists understand that gender is a nonbinary construct that allows for a range of gender identities”

This is an ideological statement. How is the APA defining gender? There is no universal agreement gender should be defined as something subjective with limitless variations believed by others. Very few people in the human population experience gender incongruence. Declaring all of gender to be a “nonbinary construct” is an overstatement. The APA may choose to engage this recently popularized language (mostly with roots in postmodern gender studies in academia) that values subjective experience over the scientific method, but a more grounded way to phrase this is:

“Human beings are a binary, sexually reproducing species with some intersex conditions that still fall under male & female. While males & females have differing bell curves for many traits, they overlap, & it is normal to have females who fall into ranges closer to male averages & vice versa. Some individuals experience incongruence with their biological sex due to factors that research indicates are both biological & environmental. Gender dysphoria is a spectrum.”

Word choice by the APA is important to your organization’s image & mission. Does the APA want to be a science organization or one that uses language derived from activist circles & identity studies in academia whose proponents often don’t engage their ideas in rigorous scientific discourse? There have always been gender outliers. That isn’t evidence the concepts & language used in current gender identity activism are all positive for mental health & society at large. Many people have adopted a myriad of identities (belief one is a shaman, MPD, the Glass Delusion) throughout history not grounded in material reality. Everyone has rights to become their happiest self. The issue regarding the wording of this section is if others around them MUST adopt their self-perception as literally true. A more critical approach is warranted.

Some context: Gender Health Query is bringing this up due to our perspective as a medical & cultural watchdog organization around pediatric medical transition & contemporary gender ideology. We formed because we are starting to observe real-world harm to young people resulting from the gender identity movement despite its positives. This section assumes that genderfluidity ideology discourse is progressive & the healthiest possible framing for people struggling with gender issues. & that if we all believe that gender is indeed a spectrum, that there are multiple genders, & that this should be validated by not only health professionals but the public at large, that dysphoric people will experience reduced problems with mental health.   

Many of us (we are an LGBT organization & trans-inclusive) have come not to believe that, & we have evidence. We range from LGB people observing body hatred issues in gender nonconforming young females not alleviated by transition to “transmedicalists” who believe that the genderqueer movement, with its myriad of pronouns & demands on the outside world for validation, is harming transsexuals (a term they embrace to distinguish themselves as having a definable medical condition). 

The language you are using in this whole section is concerning because demands are being made. Demands that psychologists not only support their clients with kindness, compassion, & coping skills but must also adopt their clients’ worldviews & subjective experience as facts about gender (217-219). & this from the APA’s Nonbinary Fact Sheet:

“Practice using singular pronouns such as they/them & zie/ hir. Using non-binary pronouns can feel awkward at first. Practicing using these pronouns outside of the therapy room will allow clinicians to get more comfortable & fluent in doing so & will make speaking with clients easier.”  

Not all LGBT people support the language used here because of where it has led. We are seeing some harm arising from telling young people that biological sex is irrelevant & that gender is a spectrum. “Harm” meaning a glorification of body dysmorphia now viewed as “cool” identities. Harm meaning an increase in stories of transition regret. Harm meaning “queer” youth who seem to have difficulty coping with even minor challenges to their worldviews about their long growing lists of sexual & gender identities & demands to be sexually & emotionally validated by people who don’t agree with identity over biology. Harm meaning any young bisexual who doesn’t want to identify as “pansexual,” or lesbian who doesn’t want sex with MtFs, is being called a bigot, an unhealthy form of sexual harassment disguised as social justice, behavior now rife in LGBT youth & even some adult spaces. Harm meaning young people who are so gender/sexually confused they are being put at risk for sexual exploitation by peers & adults online & in real life in “queer” spaces. Harm meaning an obsession with identity in youth culture over accomplishment & human values. We have many examples to justify these statements (see genderhq.org).

Guideline 2. Psychologists understand that gender identity & sexual orientation are distinct but  

Mental health professionals should educate themselves on the specific & often-ignored needs of trans people & that trans & sexual orientation are two different things. 

It is also important to acknowledge the association of even intense childhood dysphoria & adult GL identity (https://www.genderhq.org/trans-children-gender-dysphoria-desistance-gay/#anchor-page1-section-b). Evidence such as “the older brother effect” indicates certain biological processes create both trans & gay outcomes. Hormone in utero effects may affect FtM or lesbian identity (https://www.genderhq.org/trans-nature-vs-nurture-innate-gender-identity-culture). This is why there is a growing community of LGB people who are very concerned about socially reinforcing a child’s cross-sex identification at age 5 & giving them Lupron as early as age 11. & the push to socially & medically transition the large increase in trans-identified bio females. We don’t know the number of medicalized false positives that will occur, but it won’t be zero. There is currently a detrans subreddit (https://www.reddit.com/r/detrans/) with thousands of people in it & most appear to be L & B young women dealing with medical side effects who transitioned at too young an age. 

In line 279, you use the term “Sexual orientation identity.” Sexual orientation is based on bio sex, as in male & female. It is not an “identity.” Individuals are free to view themselves as they wish. But our org. protests any attempt by mental health bodies to define gay & lesbian people based on gender identity & not same-sex attraction. We aren’t alone in this. If the APA adopts the stance that sexual orientation is something one can identify into, you are taking sides on an issue that is extremely contentious. You will be taking a position many gay men & lesbians view as offensive to the interests of their minority groups. Why? The answer is in the way this ideology plays out in the real world. Contemporary gender identity activism (that uses the same language used in this document) is framing gays & lesbians as bigoted for not including dysphoric, opposite-sex people in their sexuality. It’s causing much strife. There are even psychologists who are “problematizing” homosexuality & heterosexuality by framing not emotionally & sexually validating trans people’s identities in terms of social justice (Blair 2018). Our board had to write a response.  https://www.genderhq.org/blog/2019/6/17/ghq-board-opinion-sexuality-as-social-justice-creates-problems-especially-among-lgbt-youth?rq=Blair

Some people in the LGB population will view the APA  as a hostile entity to LGB identity if you validate the concept one can identify into homosexuality or gay & lesbian identity or that bisexuality is anything other than attraction to the 2 biological sexes. Changing these definitions reflects genderqueer activism, not facts.

Line 266 “range of gender identities that exist.”

The APA may want to consider if adopting queer theory views of gender as a spectrum is helping in the real world as it relates to NB-identified people. Most research showing benefits of transition relates to binary FtM & MtF. While studies such as Russel (2018) show a boost in happiness if pronouns are respected, & this may include third gender pronouns, other studies indicate many people are not being helped by the rise in the NB identity. Several studies on NB identities show they have worse mental health than binary trans people (Jellestad 2018, James 2016, Tebbe 2016). This is often blamed on the outside world’s failure to validate them properly. Our position is that youth should not be encouraged to seek & demand validation from others to achieve happiness, but the current genderqueer movement relies heavily on this concept.

Other plausible scenarios are persons may adopt an NB identity due to ASD, BPD, BDD, HPD, NPD, or AGP. They may be struggling with internalized anti-gay/lesbian feelings. There are personal accounts that say so & at least one study that shows homophobic bullying increases the likelihood of trans identification (Delay 2017). They may be experiencing a female inferiority complex as one of the many females identifying as trans or NB in exploding numbers. The compassion in this section is good. We want support for GNC people too. We must create space in society for them & support them. We ARE them as an LGBT organization. But mental health is complex & mental health issues should not be rebranded as “identities” because we believe that is what we see in some cases. Given affirmative model advocates openly admit minors are undergoing permanent medical alteration like double mastectomy for NB identities, the APA must look at what is causing this increase in mostly female minors with these identities. We are seeing more stories of transition regret & some of these mostly lesbian & bisexual or ASD young women had adopted NB identities.

Guideline 5. Psychologists recognize how stigma, prejudice, discrimination, & violence affect the health & well-being of TGNC people. 

“Discrimination can include…not using a person’s preferred name or pronoun”

We hope the APA believes there are limits to defining not using preferred pronouns as “discrimination” given there are now dozens of them. Is an LGB person or transmedicalist “discriminating” against someone if they do not believe in pronouns such as ze, ve, zir, they, & it, all pronouns you will see people use. The APA must be mindful not to advocate for imposing worldviews on others who may not agree with them by framing it as bigotry & discrimination. This is an increasing problem in academia & has infiltrated science bodies. Real discrimination is kicking someone out of a home or firing them.

Discrimination, suicide ideation, mental health issues, & violence inflicted on poor black & brown people are all real issues that must be addressed. We also see a huge amount of paranoia in the trans community that is not in line with reality when one examines crime statistics. Trans people overall may not be at higher risk for violence relative to other groups such as women in general or black men. & the media reported murders, with hyped headlines, often involve situations where they weren’t targeted in an anti-trans hate crime. One study shows they are at lower risk for violence than women overall. Since anxiety, depression, suicide ideation, & paranoia are all socially contagious phenomena, it is best to educate trans people about how to be mindful to keep themselves safe & healthy without fomenting fear that may harm their mental health and make them feel hated. Targeted programs for poor people at risk for drug addiction & prostitution are most needed. Trans people can live safe & happy lives in tolerant areas. It is crucial to promote messages of hope.

https://www.channel4.com/news/factcheck/factcheck-how-many-trans-people-murdered-uk

https://quillette.com/2019/12/07/are-we-in-the-midst-of-a-transgender-murder-epidemic/

https://www.washingtontimes.com/news/2019/dec/8/transgender-homicide-rate-remarkably-low-despite-h/

This section mentions “stigma.” Our position is that many mental health professionals are participating in stigmatizing autogynephilia by refusing to recognize it exists due to political pressure from certain activists. Many trans people admit they experience this. We believe we see a lot of harm, shame, & acting out resulting from people participating in AGP denial. 

https://www.genderhq.org/trans-youth-identity-politics-rights-conflicts-lgbt-part3

The APA should start talking about this condition openly. We consider it malpractice to continue to deny it exists, which may prevent a therapist from helping people in the most honest way possible without shame.

Guideline 7: Psychologists understand the need to promote social change that reduces the negative effects of stigma on the health & well-being of TGNC people. 

Some concerning parts of this section-

"Psychologists may choose to become involved with an organization that seeks to revise law & public policy"

"Psychologists may consult the National Center for Transgender Equality"

This is an ideological trans rights organization. For example, they make these claims about trans students- "Some are denied opportunities to go on field trips or participate in sports."

This is a lie. People want policies to protect female students & female sports. All evidence is leading to MtFs having very significant biological advantages in sports over biological females even once they medically transition (https://fairplayforwomen.com/sports/). MtFs are blowing away females in track in high school and college, for example. No one is preventing anyone from participating in sports based on biological sex. FtMs on testosterone may be included in male sports if they wish as they will still retain a disadvantage but have unacceptable advantages over girls and women. We believe males need to learn to be kind & compassionate towards gender nonconforming males who may identify as girls, not force girls to be nurturers at the expense of their ability to win sports competitions because they don't matter as much as a male with GD. There is a trans Muay Thai fighter who identifies as a trans woman & fights males and recognizes they are trans & takes pride it that. This is preferable role-modeling, not forcing society to deny biological reality.

Imagine an unaltered MtF goes on a field trip, stays in sleeping quarters with a girl & has consensual sex with her on a school field trip. She gets pregnant. That is a situation where the parents will have every right to sue the school. A school worried about this is not "discriminating" against a trans student who is undoubtedly allowed to attend field trips as any other student. Safe, compassionate accommodations must be made for all. The APA should not follow organizations such as this uncritically for advice.

The APA should stay away from inserting itself "to promote social change" when it results in potentially harming other groups. Adhere to "change" that protects the safety, health, & ability to live & work for trans people. If you go beyond that & promote current gender identity activist demands like MtFs are "literally female," you will be viewed as an anti-woman & anti-LGB rights organization by many. The eradication of women's sports, prisons, rape crises centers for biological females, medicalizing children who may be pre-LGB, & eliminating the ability to collect valid data regarding sex due to the change of public records are very contentious issues. Many people, including conservatives, far leftists, trans-rationalists, LGB people, parents, feminists, scientists, and detransitioners are working against some of the biology denialism in current gender identity activism. LGB people are breaking off from LGBT organizations to form new ones due to this ideological capture. Best avoid "promoting social change" in those areas unless you want your organization torn apart by this.

Guideline 8. Psychologists working with gender-questioning 4 and TGNC youth understand the different developmental needs of children and adolescents, and that not all youth will persist in a TGNC identity into adulthood. 

"As a result, this research runs a strong risk of inflating estimates of the number of youths who do not persist with a TGNC identity."

This is debatable when one takes a close look at the Steensma study.

https://medium.com/@jesse.singal/everyone-myself-included-has-been-misreading-the-single-biggest-study-on-childhood-gender-8b6b3d82dcf3

We review desistance stats here. 

https://www.genderhq.org/trans-children-gender-dysphoria-desistance-gay

We already know false positives on minors are happening. We just don't know the numbers. The APA should take this on as an ethical duty. Detransitioners will be a growing population. We see rapid validation of trans identity in minors by psychologists leading to irreversible medical consequences. At the same time, we see young people who meet full DSM criteria but are desisting or detransitioning. These are minors being put under extreme medical protocols. It's good always to be mindful of this reality. Transition underage is considered a human right now. Is growing up without being permanently medically altered for intense, but ultimately transient feelings a human right? We believe it is. 

We consider stories like this malpractice. This 15-yr-old girl would have taken testosterone had her father not let her before desisting after meeting DSM criteria. As a medical watchdog org, we hear a lot of stories like this. Altering physically healthy bodies underage would normally be considered a major human rights violation. The inevitable false positives on mostly pre-LGB youth, ASD, and girls with trauma that will result from transitioning youth before brain maturation are acceptable collateral damage to trans-positive healthcare. This is the reality of the new paradigm, and we would like to see organizations like the APA be more upfront about it, given the serious medical consequences. For example, altering pre-LGB youth can be considered akin to what was done to intersex babies when doctors surgically altered them given the Lupron to estrogen protocol stunts genital growth, and they are doing surgeries underage now. 

https://www.genderhq.org/blog/2020/4/8/teen-girl-outgrows-gender-dysphoria-dangers-pediatric-medical-transition

Medical transition under age causes sterility, may permanently destroy sexual function and may impact cognition and bone health.

https://www.genderhq.org/trans-youth-side-effects-hormone-blockers-surgery

"Much greater consensus exists regarding practice with adolescents. Adolescents presenting with gender identity concerns bring their own set of unique challenges."

This comment should be removed. The demographics of this condition have completely changed, with many more females seeking SRS, more heterosexual females wanting to be gay men, and an overall increase in youth requesting medical treatments. There is not a consensus about what to do. The Tavistock gender clinic in the UK has seen multiple public resignations. That doesn't indicate "consensus." It indicates safeguarding and ethics problems. It's unethical as a mental health body to not to take a closer look at ROGD and other trends when one sees these graphs. We believe there is very robust evidence GD is a socially contagious and iatrogenic condition for some people, particularly female teens and YAs. 

https://www.genderhq.org/increase-trans-females-nonbinary-dysphoria

Much evidence points to social factors contributing to GD. Society is currently being set up to maximize the number of medicalized young people.

https://www.genderhq.org/trans-nature-vs-nurture-innate-gender-identity-culture/#anchor-page10-section-a

Guideline 11. Psychologists recognize that TGNC people are more likely to experience positive life outcomes when they receive social support or trans-affirmative care.

We have reason to believe younger cohorts will have more regret and less positive mental health outcomes due to the substantial increases in the numbers of young people transitioning and the move to the affirmative model and informed consent model for adults. For example, the Williams Institute study is touted as an example of a study validating the need to offer easy medical transition access. But if one looks at the question about passing better, there is no benefit. In that study, natal females (in contrast to natal males) who say other people don't recognize them as trans or GNC have the same or higher suicide attempt rate as females who are dysphoric and recognized as female, not male. 

If you look at Lipson (2019) there are incredibly high rates of mental health problems among the trans college students surveyed. This is at a time when celebration of trans identity is at an all-time high. And college students are often given access to transition healthcare. Yet the rate of mental health problems is alarming, particularly among biological females. Given it is known females are prone to body dysmorphia contagions or BPD, which involves identity instability, we hope the APA is asking questions beyond blind affirmation. We are seeing many therapists blindly and immediately affirming young people assuming transition will solve all of their problems. It's one reason we felt we had to form GHQ.

Another recent study (Branstrom 2019) calls into question the overall benefits of SRS on mental health. The conclusions of this study initially claimed a benefit. The study had to be corrected after several LTEs pointed out major flaws. It showed no benefit. It's disingenuous they have not changed the title, and bias may be involved in them not retracting it altogether. 

https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2019.19010080?journalCode=ajp

https://www.genderhq.org/blog/2020/8/19/american-journal-of-psychiatry-study-purported-to-show-benefits-of-transgender-medical-transition-made-false-claims 

We review the positive studies on GHQ.  

https://www.genderhq.org/trans-youth-suicide-statistics-kill-themselves-manipulate-parents/#anchor-page15-section-b-what 

We also cover studies such as Dhejne, Adams, and Marshall that call into question the positive effects of medical transition in the long run on mental health & suicide risk.

https://www.genderhq.org/trans-youth-suicide-statistics-kill-themselves-manipulate-parents/#anchor-page15-section-b-below

The APA may want to take a closer look at what is going on now rather than rely on the Cornell review and other positive studies. Detransition and rapid onset gender dysphoria (Littman 2018) will likely be growing topics. Please don't acquiesce to the intense and often successful efforts to shut this down.

https://www.reddit.com/r/detrans/

https://www.genderhq.org/trans-activism-identity-politics-harassment-censorship

Guideline 15. Psychologists respect the welfare and rights of TGNC participants in research and strive to represent results accurately and avoid misuse or misrepresentation of findings. 

“One group of experts has recommended that population research, & especially government-sponsored surveillance research, use a two-step method, first asking for sex assigned at birth, & then following with a question about gender identity (GenIUSS, 2013).”

Yes- it is critical to collect data knowing the biological sex of all involved. This is creating problems. We look at studies on LGBT youth and we don’t even know the biological sex of those involved. It’s an example of the many problems identity over biological reality causes. Scientists, women, gay people, and trans people all need access to proper data.

Thank you so much for allowing us to participate.

Case of Teen Girl Desisting from Gender Dysphoria Highlights Conflicts and Dangers Around Pediatric Medical Transition

A parent sent an email to Gender Health Query about a teenage girl who met DSM diagnostic criteria for gender dysphoria. One parent and the mental health and medical professionals were all enthusiastic to medically alter this girl's body, who eventually outgrew her feelings. The story highlights conflicts that are arising between parents around their child's trans declaration, the involvement of the courts, and how early medical treatment endangers grey area children/teens/young adults.

Slightly edited (for anonymity) and posted with permission:

Subject: My daughters desistance

Message: Briefly, I would like to share that my daughter, who has recently desisted, had identified as transgender (FTM) for over 2 years, from age 13-15. During this entire period, she regularly pressured me and my ex that she needed medicalization with hormones. I very carefully resisted the pressure while showing support. My ex, however, was very supportive and showed eager willingness to allow her to medicalize. My ex also used my resistance to medicalization to try to show family court I was not supportive of my daughter's coming out as TG. My ex exploited this (along with some parent/child conflict) in an attempt to limit my parental rights and parenting time. This was a source of great conflict, for us as co-parents. Throughout her court challenge, a few mental health professionals were brought to the case to give opinions. We also hired an LGBTQ "specialist" for therapy for my daughter. All the mental health pro's recommended the affirmation approach and encouraged seeking out consultation for puberty blocking or hormone therapy. At one point, in the presence of my child, I asked the LGBTQ specialist if she, and my daughter, had discussed testosterone therapy and its side effects. She replied that, yes, they had. I asked, "Have you had the conversation about how 'T' has irreversible side-effects." The "specialist" flatly denied that this was true, to me, in front of my child. She stated that the effects of T are reversible. I know that this is not true, as I had done diligent research on TG medicalization. I was appalled that a therapist claiming to be a transgender specialist would be so uninformed. She was also unaware of what WPATH was.

Recently, My daughter has desisted and is back to identifying as her natal gender. The cessation of the two years of identification happened almost as fast as her coming out as TG two years prior. It terrifies me to think that, had I lost parenting rights/decision making during my ex's court challenge, my daughter may have been allowed to medicalize her transition. It terrifies me that there is a mental health community (who may have very little understanding/training/information) that is encouraging medicalization of children.

Through the process of transition, I reluctantly consented to a consultation at the Children's Hospital Transgender Clinic here in ****. I consented under pressure from my ex with her court case. I felt I had to show that I was supportive of my child's TG identification. Fortunately, there was a 6+ month waitlist for a consultation. I fear if we had gone to our consultation, the TG Clinic might have recommended hormone therapy. This would give my ex more professional backing (along with other mental health professionals opinions) to either pressure me to consent to medicalization or, worse, the court to limit my parental decision-making rights. Luckily my daughter desisted before her name came up on the waitlist.

When I called the Transgender clinic to remove my daughter's name from the waitlist, I asked the staff member if the TG Clinic kept data and statistics of children who were in the program, or on the waitlist, who had dropped out due to desistance. She said she was not aware of any data collection of that type. There seems to be so much disinformation on desistance rates for TG kids. I feel desistance rates are under-reported. I feel, during this era where child referrals to TG clinics have skyrocketed (particularly for teen FTM's), there needs to be reliable data collection on desistance rates to be used for additional research. Also, this data would be most useful in making clinical decisions on whether or not to medicalize certain age groups, like teenagers. I have no idea how trans gender clinics are accredited, but perhaps keeping accurate data on program desistance rates should be a condition of accreditation.

I'm appreciative of this web site and organization. I'm thankful to share. I'm curious to hear others' thoughts on desistance rates data collection.

Sincerely,

****

Detransition and Gender Dysphoria

News Links

Detransition and regret rates appear to be increasing. Most regretters appear to be biological females and lesbians. Below are several links to articles about desistance and detransition.

1) This research paper acknowledges the complications in treating gender dysphoria in minors. Cases of desistance are reviewed.

“‘Taking the lid off the box’: The value of extended clinical assessment for adolescents presenting with gender identity difficulties:”

Abstract

As the number of young people referred to specialist gender identity clinics in the western world increases, there is a need to examine ways of making sense of the range and diversity of their developmental pathways and outcomes. This article presents a joint case review of the authors caseloads over an 18-month period, to identify and describe those young people who presented to the Gender Identity Development Service (GIDS) with gender dysphoria (GD) emerging in adolescence, and who, during the course of assessment, ceased wishing to pursue medical (hormonal) interventions and/or who arrived at a different understanding of their embodied distress. From the 12 case‘Taking the lid off the box’: The value of extended clinical assessment for adolescents presenting with gender identity difficultiesTaking the lid off the box’: The value of extended clinical assessment for adolescents presenting with gender identity difficultiess identified, 2 case vignettes are presented. Implications for the development of clinical practice, service delivery and research are considered.

2) Finland plans to study transition regret and detransition.

“Study aims to chart transition regret in Finland:”

"I wish I'd never done it"

Twenty-seven year-old Nita said her mental health problems were not adequately addressed before she began a medical female to male transition.

Nita said she's not alone and that she knows several people who have transitioned back to their original gender.

Irreversible effects

Nita began transitioning to male in her 20s, saying she approached transitioning lightly, akin to getting a tattoo. To make her body more masculine, Nita took testosterone and had a mastectomy.Study aims to chart transition regret in Finland

“The whole trans process injected meaning into my life. There was a constant goal to work towards,” she explained. “Now it bothers me that I’m a 27-year-old woman who sounds like a teenage boy.”

3) Carey Callahan has been an outspoken detransitioned women who is part of a group for individuals who have, or want to seek, medical transition services called Gender Care Consumer Advocacy Network. She addresses the libertarian transition environment under “informed consent.”

“Gender identity is hard but jumping to medical solutions is worse:”

The day I knew I should quit my job answering phones at the transgender health-care clinic in California was the day a caller (let’s use the name Betty) threatened her in-home caretaker with a knife during the call. As the caretaker begged our clinic’s nurse to track down Betty’s doctor and tell him that Betty was having a psychotic episode, Betty stood between her and the apartment’s front door with a kitchen knife. Betty had poorly controlled paranoid schizophrenia, and often called the clinic agitated, alternately whispering and screaming about government agents stalking her. Betty was also a trans woman whom most people regarded as male, the sex of her birth. 

The clinic followed the “informed-consent” protocol: its mission was to provide transgender patients who otherwise lacked access to health care with injections, skin patches and pills of feminising or masculinising hormones without having to pass through a series of requirements and assessments—known as “gatekeeping”—that restricted access in the past.

In medicine broadly, informed-consent refers to the ethical requirement that a clinician administering a treatment communicate to the patient the anticipated risks and benefits, as well as reasonable alternatives to the treatment. Yet for transition medicine in America, informed-consent programmes do not require clinical documentation, beyond patient reports, of the patient’s gender dysphoria over time (ie, a feeling of mismatch between one’s biological sex and gender identity) and readiness for medical interventions. 

Gatekeeping horror stories are notorious in the transgender community.

4) Lisa Marchiano is an LCSW who works with detransitioned people.

“The Ranks of Gender Detransitioners Are Growing. We Need to Understand Why:”

The young women with whom I have worked became trans identified during adolescence. They frequently did so in the context of significant family dysfunction or complex psycho-social issues. Sexual assault and sexual harassment were common precursors. A majority had an eating disorder at the time they became trans identified. Since detransitioning, most now understand themselves to be butch lesbians. In our work together, they traced complex histories of coming to terms with their homosexuality. Some faced vicious homophobic bullying before they announced their trans identification…

Dismissing detransition as a “panic” stirred up by biased media outlets does a grave disservice to the real men and women who are struggling through the difficult experience of detransition. It isn’t good science—or good journalism—to ignore a category of people simply because their pain is politically inconvenient.

5) The BBC has also recently covered the topic of detransition here and here.

6) Dr. Lisa Littman is doing a research study on desistance and detransition.

7) A video on “Detrantransition and Retransition” from National LGBT Health Information.

8) Several videos below cover individuals’ experiences with transition regret:

“A Woman's Place is marching on together (Leeds, 22nd November 2019) Thomasin Pick”

“Thoughts on butch erasure (FTM detransition)”

9) Storm Ryan, a well-known trans Youtuber, is very alarmed at the exploding numbers of trans-identified teens.

“my last trans vid ever”

News in Detransition

News

Over the last several weeks, there have been multiple articles on the once rare and under studied topic of detransition.

Charlie Evans is a bisexual woman and is starting a detransition advocacy organization. This is an article by Evans on Medium:

“The medicalization of gender non conforming children, and the vulnerability of lesbian youth”

More from her can be found here https://medium.com/@charlie.evans

This is a link to the crowdfunded page for the detransition advocacy organization:

“The Detransition Advocacy Network”

And a petition asking the public health service in Britain to study and support detransitioners:

“Support Detransitioners at the National Institutes of Health”

Two articles about detransition and Charlie Evens:

'Hundreds' of young trans people seeking help to return to original sex”

“Why is the progressive world so hostile to detransitioners?”

Evans identified as male for nearly a decade, but then changed her mind. And Evans is not alone. She says she has been in touch with hundreds of other young people who have detransitioned, mostly people in their early 20’s. Some of these individuals have had full gender reassignment surgery, and regret it. All are trying to figure out how to move forward and live happy, healthy lives.

There is a new detransition resource in Sweden:

“För mer kunskap och stöd kring detransition”

This is a Dutch documentary on detransition:

“Transgender Regret - A Dutch Documentary”

Below is a video of a story of a detransitioned woman who fit the definition of DSM-5 gender dysphoria from childhood and transitioned as an adult. She believes transition helped prevent her from committing suicide but also run from her butch identity:

“Thoughts of a detransitioned woman”

A personal story of homophobia and transition regret:

“I Spent a Year as a Trans Man. Doctors Failed Me at Every Turn”

At the time, you wouldn’t have been able to tell I was gay just from looking at me. I had long, blond hair, wore makeup, and carried myself rather femininely. But in my head, I knew I was gay—though I was more of a self-loathing gay. 

The truth is, I didn’t like gays, and didn’t want to be associated with them. Yet there I was, dating only other girls…

At age 18, I started seeing a bunch of transgender men’s “success stories” on Instagram. The trans men talked about how something had always “felt off” with them, and they said people couldn’t tell they had been the opposite sex after their transition.

Their stories all seemed to have a happy ending—and it made me rather jealous. 

Here I was getting frowned upon for holding hands with my girlfriend in public, feeling like I’m constantly being judged by everyone, while transgenders could date their same-sex significant other while looking like the opposite sex. 

I resented that and began to envy the transgenders. I looked into it for myself.

Stonewall UK added to the discourse by attempting to debunk some recent narratives emerging about detransition and attributing it to transphobia. These points run contrary to most recent stories about detransition. Many deransitioners claim they never report their detransition to any official entity and that they feel transition was a mistake:

”Dispelling myths around detransition”

Jesse Singal, who has been reporting on the contentious issue of pediatric medical transition and detransition, discussed some problems with the Stonewall UK statement on his personal blog:

”LGBT People Deserve Accurate Information From LGBT Organizations: But they aren't getting it”

The blog is behind a paywall, but he posted some of his commentary on social media:

Andrew Sullivan is joining the ranks of LGB people who are concerned about tranistion regret in LGB and other youth. He has written an article about detransition called “The Hard Questions About Young People and Gender Transitions:”

The widespread consensus today is that detransitioning is so rare even mentioning it borders on transphobic. But in reality, absolutely no one knows how rare detransitions are currently — the small set of research studies detransition skeptics present as evidence that it is very uncommon all come from vastly different contexts, in some cases decades-old, and arguably don’t capture what’s going on in 2019. These women live every day with the consequences of their decision: tenacious facial hair (one has to shave every three days) and body hair, deeper voices, permanently enlarged clitorises. They also suffer from the effects of “binding,” i.e. wearing a breast corset of sorts, to flatten their chests, so they can pass more easily as men. “I have back issues, lower lung capacity, and permanent dents around my shoulders,” one told me. “Every now and again, I have to push a rib back in to breathe,” another recounts. “I have permanent bruising,” another explains. “Serious back issues,” says another, who cannot carry a backpack for long without pain. “We get ‘sir’ed at Dunkin’ Donuts every time,” one joked…

By their own accounts, they had been adamantly trans in their teens. “I was the student trying to get a professor fired because he wouldn’t allow theyand them to be used for a singular person in my papers … I threatened my parents and friends with suicide. It became part of my identity to be suicidal. I screamed at my parents about this, even though I knew I wasn’t going to kill myself.” One went by the pronouns xe and xer and flew into a rage if she was misgendered. Once they had transitioned, and felt miserable nonetheless, they felt that this too was just part of being transgender. One talked of “the hunger to suffer.” Another spoke of “using your pain to validate your own destruction.”

A website called Canadian Gender Report has posted an informal survey of the r/detrans sub Reddit. Given that there is no formal attempt to study detransition at this time, informal surveys such as this one, and the one referenced, are the only efforts available to help understand this population.

References:

Canadian Gender Report. (2019, October 17). From trans to detransitioner – what can we learn from this growing trend? Retrieved from https://genderreport.ca/detransitioners-what-can-we-learn/

Evans, C. (2019, Septmember 9). The medicalization of gender non conforming children, and the vulnerability of lesbian youth. Medium. Retrieved from https://medium.com/@charlie.evans/the-medicalization-of-gender-non-conforming-children-and-the-vulnerability-of-lesbian-youth-10d4ac517e8e

Emmons, L. (2019, October 10). Why is the progressive world so hostile to detransitioners? The Post Millennial. Retrieved from https://www.thepostmillennial.com/why-is-the-progressive-world-so-hostile-to-detransitioners/

Lockwood, S. (2019, October 5). 'Hundreds' of young trans people seeking help to return to original sex. Sky News. Retrieved from https://news.sky.com/story/hundreds-of-young-trans-people-seeking-help-to-return-to-original-sex-11827740

Russell, N. (2019, October 8) What The First Nonbinary American Wants The Supreme Court To Know About Transgenderism. The Federalist. Retrieved from https://thefederalist.com/2019/10/08/what-the-first-nonbinary-american-wants-the-supreme-court-to-know-about-transgenderism/#.XZyM1mqNpSM.twitter

Singal-Minded. (2019, October 9). LGBT People Deserve Accurate Information From LGBT Organizations. Retrieved from https://jessesingal.substack.com/p/lgbt-people-deserve-accurate-information

Stella, C. (2016, September 3). Female detransition and reidentification: Survey results and interpretation. Retrieved from https://guideonragingstars.tumblr.com/post/149877706175/female-detransition-and-reidentification-survey

Stonewall UK. (2019, October 9). Dispelling myths around detransition. Retrieved from https://www.stonewall.org.uk/about-us/news/dispelling-myths-around-detransition

Sullivan, A. (2019, November 1). The Hard Questions About Young People and Gender Transitions. New York Magazine. Retrieved from http://nymag.com/intelligencer/2019/11/andrew-sullivan-hard-questions-gender-transitions-for-young.html?utm_medium=s1&utm_campaign=di&utm_source=tw

Thoughts of a detransitioned woman. (2019, September 27). Retrieved from https://www.youtube.com/watch?feature=youtu.be&v=aVse3ZKD9hA

Wright, S. (2019, October 7). I Spent a Year as a Trans Man. Doctors Failed Me at Every Turn. The Daily Signal. Retrieved from https://www.dailysignal.com/2019/10/07/i-spent-a-year-as-a-trans-man-doctors-failed-me-at-every-turn/

Two new studies on Gender Dysphoria in Minors

News

We are updating our site with two new studies about minors with gender dysphoria, one that shows a slight improvement in mental well-being in more recent cohorts, and one that calls into question the efficacy of social transition.

The researchers in the Netherlands, who started the hormone blocker to cross-sex hormone protocol, released a study called “Re-evaluation of the Dutch approach: are recently referred transgender youth different compared to earlier referrals?”

The Dutch clinic is seeing large increases in the number of females seeking transition. This is the case in all western countries.

Arnoldussen (2019)

They comment on this increasing number of females:

One suggested theory to explain this shift is that it is easier for birth-assigned females to be open about their transgender feelings, since they experience less stigma when they behave masculine than birth-assigned males who behave in a more feminine manner [16, 31, 32, 33].

Gender clinicians rarely consider the alternative, that masculine girls are bullied for being masculine and don’t value themselves as gender nonconforming girls. Several detransitioned lesbian/bi youth have said this was the case for them and there is evidence homophobic bullying of gender nonconforming youth (also never referenced in these studies) fuels trans identification.

Contrary to other studies with high rates of mental health issues, they note a slight improvement in their recent cohort:

In addition, although we hypothesized that is was possible that present referrals had more psychological problems, the opposite seems the case. Our analyses showed that psychological functioning of the referred adolescents improved somewhat over time. This could be explained by a subtle improvement in externalizing problems and better peer relations. It might be the case that it has become easier to openly identify as transgender in recent years, so that recent referrals do not have to stand up as fiercely for themselves as earlier referrals. In addition, they seem more accepted by peers.

The clinic expresses no concern about social contagion, as other scientists/doctors are, and attribute these increases to more youth coming out and feeling accepted. They also cite superficial similarities to earlier cohorts and recent cohorts, including a large increase in females, to possibly insinuate the groups are the same.

This may suggest that in the early years, only the tip of the iceberg of the actual number of transgender youth was presented to a transgender clinic and this iceberg has come to surface in recent years.

Wong (2019), "Childhood social gender transition and psychosocial well-being: A comparison to cisgender gender-variant children," is another recent study examining the mental health of youth who have been socially transitioned. The sample size is decent, 266 children. Unlike the Trans Youth Project studies often used to justify early social and medical transition, this study has a control group. And unlike Olson (2016), these socially transitioned young people may not have significantly improved mental health.

A quote from the results, emphasis ours:

Results: There was little evidence that psychosocial well-being varied in relation to gender transition status. Parents of CGV children were generally accepting of childhood gender variance, but only poor peer relations predicted lower psychological well-being among these children. Conclusion: Socially transitioned children appear to experience similar levels of psychosocial challenges as CGV children. While further research is needed to evaluate possible effects of childhood social gender transition on well-being, this study suggests experiences of psychosocial challenges among gender-variant children require monitoring irrespective of transition status, and relationships with peers may be especially important to consider.

They report peer relations is a key factor. Poor peer relations actually drives some children towards trans-identification as cited above. It’s worth exploring if more acceptance for gender-variant behavior reduces the need for medical transition to conform to heterosexual gender and sexuality norms.

References:

Arnoldussen, M., Steensma, T.D., Popma, A. et al. Re-evaluation of the Dutch approach: are recently referred transgender youth different compared to earlier referrals? European Child & Adolescent Psychiatry. 1-9 doi.org/10.1007/s00787-019-01394-6

Lane, Bernard. (2019, September 25). Trans care inquiry backed. The Australian. Retrieved from https://www.theaustralian.com.au/nation/doctors-back-inquiry-on-kids-trans-care/news-story/6f352bc99da430b194620a2605e8a50d

Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3), e20153223. doi:10.1542/peds.2015-3223

Wong, W. I., van der Miesen, A., Tjonnie G., F., MacMullin, L., & VanderLaan, D. (2019). Childhood social gender transition and psychosocial well-being: A comparison to cisgender gender-variant children. Clinical Practice in Pediatric Psychology,7(3), 241-253. doi.org/10.1037/cpp0000295

Health Professionals Taking a More Critical View of Youth Gender Dysphoria Treatment

News

Recent blog posts on the GD Working Group website (a site generally taking a more skeptical view of immediate affirmation and medical transition) indicate some doctors are concerned enough about current gender dysphoria protocols (often recommended by official health entities) to write some of their own information.

Professor Dianna Kenny, PhD (”KEY ISSUES IN DECISION-MAKING FOR GENDER TRANSITION TREATMENT: Questions and answers”):

In this article, I address key issues in the transgender debate as they pertain to children and young people. These include: Are “gender transition treatments” safe, “curative” and in the child’s best interest? In considering these questions, I explore the known negative consequences of puberty suppression and cross-sex hormones, including infertility and other medical conditions and the purported increase in suicidality without treatment. Can children and young people give truly informed consent to these interventions? What role should parents play in decision-making? On what basis are decisions made to proceed to gender transition? Are the foundations of such decisions logical and scientific? and What social forces are at play in this decision-making process? 

Safety: Does the current scientific evidence support a conclusion that the administration of Gender Transition Treatment (social transition, puberty blocking agents and cross-sex hormones) can be safe for children and adolescents?

Answer:  No. 

She goes on to list many of the associated health problems with medical transition also covered on our site. These include circulatory health risks, risks to bone health and cognition, sexual problems, and other issues.

She also addresses the data on suicide risk:

…though the suicide risk in this population is high, as the table below attests, there is scant research evidence that gender transition treatment results in lower risk for suicide. There is also a problem in studies on gender dysphoria and suicidality related to how suicidality is measured. Different rates will be obtained in different studies because of the use of different forms of measurement. For example, being asked if you have suicidal ideation will produce higher rates than counting the number of potentially lethal suicide attempts (Aitken, VanderLaan, Wasserman, Stojanovski, & Zucker, K. (2016).

She makes a more definitive statement:

Transgender treatment does not prevent suicide, and may have other adverse effects on mental health post transition.

This assertion may be debatable. Suicide risk post transition remains high. Many studies show improved mental health and suicide risk post transition. A few show that transition does not resolves many problems dysphoric people face. GHQ has a review of most of the pertinent studies surrounding the issue of suicide with a motivation to present the issue as honestly as possible.

Most associated with GHQ would agree with her concern about the affirmative model and lack of mental health support in favor of transition offered as a solution to all problems:

The vexed question is one of causality. Does gender dysphoria cause suicidality or is it the discriminatory treatment and social exclusion suffered by the transgender community that is causative, or are suicidality and gender dysphoria caused by a third factor, such as mental illness, family dysfunction, parental or social factors? In my work with transgender adolescents, I have noted with great concern the serious underlying emotional disturbance in these young people who need intensive psychotherapy and parental and family therapy to resolve these disturbances. I wonder about those who go straight to gender clinics and gender affirming professionals who skate over these cracks in their personalities and social adjustment and proceed to gender transition in the naïve belief that this will resolve all of their presenting difficulties

She goes on to address issues of age of consent, the politcized climate shutting down debate, and the importance of the inclusion of parental feedback.

Dr, William Malone, critical of the medical establishment’s embrace of the affirmative mode (which includes medical treatment on minors) has written up some of his own guideline suggestions (“Gender Dysphoria Resource for Providers”).

References:

GD Working Group. (2019, August 9). Key Issues in Decision-making for Gender Transition Treatment: Questions and answers. Retrieved from http://gdworkinggroup.org/2019/08/09/key-issues-in-decision-making-for-gender-transition-treatment-questions-and-answers/

GD Working Group. (2019, August 2nd). Gender Dysphoria Resource for Providers. Retrieved from http://gdworkinggroup.org/2019/08/02/gender-dysphoria-resource-for-providers/

We do not have open comments on the Gender Health Query website. But that doesn’t mean we aren’t interested in what you have to say. If you have a comment, blog post idea, or any other feedback, we would be interested if the information can be supported by science research, an informed opinion, real-world observations, or personal experiences. Please contact us.

A Call for More Research into the Safety of Medically Transitioning Minors for Gender Dysphoria in Australia

News

Several professionals are calling for an inquiry into the raising numbers of youth being medically treated for gender dysphoria. The story covered in The Weekend Australian is called “Warnings over surge in youth transgender cases:”

The call for an inquiry by health sociologist Geoff Holloway, who wrote the submission, has been backed by 2019 Senior Australian of the Year paediatrician Sue Packer, Western Sydney University paediatrics professor John Whitehall and developmental psychologist Dianna Kenny.

One doctor is very critical about what has been happening:

“Who gave ethics approval for this treatment (at children’s hospitals) when it lacks any scientific basis and therefore is an experiment?” Professor Whitehall said. “We should give the psychiatry and psychology a full run before we start castrating children.”

Critics make a point made on the GHQ website that blockers may prevent desistance:

Critics point out virtually all those on blockers go on to cross-sex hormones (and sometimes surgery), meaning an irrevocable transition to a medical approximation of the opposite sex. This makes them lifelong patients with a range of potential compli­cations and a high risk of infertility, clinicians say.

Commentary on the politicized climate:

Critics say still-maturing young people are immersed in a world where many parents, teachers, clinicians, friends and social media are captured by emotive promotion of trans status, while activists try to suppress scepticism or inquiry as “hateful transphobia”.

Dr Holloway, who says the role of culture in gender dysphoria is unmistakeable, said: “People who object to what’s going on, they can lose their jobs, quite apart from being ostracised. This is supposed to be a scientific endeavour, not a witch hunt.”

This story is similar to what some health and social science professionals are doing in the U.K.

Another similar article about health professionals in Australia can be found in here.

Update 08/17/19: Another Australian article on this topic: "'They're being fast-tracked': Psychologist wants inquiry into children's transgender clinics"
Update 08/18/19: Relevant TV program on this topic: “‘Lots of factors’ converge to increase child transgender treatment”
Update 08/24/19: Another Australian article on this topic: “Trans medical model to bear ‘cost of regret’,” “Parents feel new gender was a foregone agenda,” “Concerns on gender transition”
Update 10/14/19: The Australian and Bernard Lane have been doing a regular series on this subject: https://www.theaustralian.com.au/author/Bernard%20Lane

References:

Hook, C. (2019, August 13). 'They're being fast-tracked': Psychologist wants inquiry into children's transgender clinics. 7News. Retrieved from https://7news.com.au/news/social/theyre-being-fast-tracked-psychologist-wants-inquiry-into-childrens-transgender-clinics-c-397125

Lane, B. (2019, August 9). Trans project ‘out of balance. The Australian. Retrieved from https://www.theaustralian.com.au/nation/trans-project-out-of-balance/news-story/aa7e3aa89a9f42d74e76b3ef31aaa961

Lane, B. (2019, August 9). Warnings over surge in youth transgender cases. The Australian. Retrieved from https://www.theaustralian.com.au/nation/warnings-over-surge-in-youth-transgender-cases/news-story/8b4efbf389a0bd61e664f93a5eaf7315

Lane, B. (2019, August 12). Trans medical model to bear ‘cost of regret’. The Australian. Retrieved from https://www.theaustralian.com.au/nation/trans-medical-model-to-bear-cost-of-regret/news-story/eb60e562a78c5ebf3c45c53d8f433cd1?fbclid=IwAR3inWWXYR1YDSGNUrFC8ZDYasHJ6nt0BArHktAHY5Z1DvJfkuvI_2y7F4s

Lane, B. (2019, August 24). Parents feel new gender was a foregone agenda. The Australian. Retrieved from https://www.theaustralian.com.au/inquirer/parents-feel-new-gender-was-a-foregone-agenda/news-story/08fe653987f5838f5a8c09d41f1cc436

The Daily Telegraph. (2019) Lots of factors’ converge to increase child transgender treatment [Video file]. Retrieved from https://www.dailytelegraph.com.au/news/national/lots-of-factors-converge-to-increase-child-transgender-treatment/video/9eee63d898aa7df17476c20dc7cb4170

Editorial Board, (2019, August 21). Concerns on gender transition. The Australian. Retrieved from https://www.theaustralian.com.au/commentary/editorials/concerns-on-gender-transition/news-story/3af1378fd499f11bd94bec3fc8dd3695

We do not have open comments on the Gender Health Query website. But that doesn’t mean we aren’t interested in what you have to say. If you have a comment, blog post idea, or any other feedback, we would be interested if the information can be supported by science research, an informed opinion, real-world observations, or personal experiences. Please contact us.

One Family Closely Involved with a Trans Support Group has Three Dysphoric Children Not Biologically Related

News Commentary

One British family associated with the controversial trans support group Mermaids, that promotes validating all gender dysphoria in children, has three dysphoric children who are not biologically related. Despite some alarm from social workers, a judge is allowing their four year old to transition.

Affirmative model advocates, such as the researchers at the Trans Youth Project, emphasize an “innate gender identity” narrative, and the promotion of these studies is being used to justify putting thousands of children on hormone blockers, giving them cross-sex hormones, and offering them surgery as minors, whether this is their goal or not.

“There’s a lot of public writing focused on the idea that we have no idea which of these gender-nonconforming kids will or will not eventually identify as trans,” says Olson. And if only small proportions do, as some studies have suggested, the argument goes that “they shouldn’t be transitioning.” She disputes that idea. “Our study suggests that it’s not random,” she says. “We can’t say this kid will be trans and this one won’t be, but it’s not that we have no idea!”

Some youth who are dysphoric as children will decide to transition as adults.

There is also a fair amount of data to support the argument environmental and cultural factors influence gender dysphoria. They are covered extensively on this site, in addition to data that supports biological causes for transgenderism and homosexuality, in the “Nature vs. Nurture” topic. One of the influences that may be environmental is family stability. Children who are adopted or foster parented appear to have higher rates of gender dysphoria (or parents who get them treated for it).

We asked a person competent in statistics to calculate the odds of having three seriously gender dysphoric children in one family based on some recent reported percentages of transgender people in the population. The first two percentages are from The Williams Institute. The third statistic is from a recent Minnesota school survey.

0.3% = (0.3/100)^3 = 27 chances in a billion

0.7% = (0.7/100)^3 = 343 chances in 1 billion

3% = (3/100)^3 = 27 chances in 1 million

This family’s situation is very rare if all three children have a biologically driven, innate gender identity.

We do not have open comments on the Gender Health Query website. But that doesn’t mean we aren’t interested in what you have to say. If you have a comment, blog post idea, or any other feedback, we would be interested if the information can be supported by science research, an informed opinion, real-world observations, or personal experiences. Please contact us.

Comments from Gender Clinicians Who Resigned from Tavistock in UK Support the Need for Gender Health Query

NEWS COMMENTARY

One of the main goals of Gender Health Query is to ensure that gender dysphoric youth are not being over-medicalized. This is in light of the fact minors are being permanently altered and that the demographics of who is seeking treatment has changed rapidly to include many more young females. Unfortunately, a recent newspaper article in the London Times confirms some of our worries.

These concerns are:

• Some youth are not receiving proper mental health support.

• They are not being given time to mature.

• Inappropriate medical transition of LGB youth is a major risk.

• Anti-gay attitudes among parents and youth themselves may be fueling transition.

• Medical procedures will have negative impacts on health.

These concerns are being raised by gender clinicians themselves as “All five have resigned from the Gender Identity Development Service (GIDS) in the past three years as a matter of conscience.”

Some quotes from the article:

“This experimental treatment is being done not only on children, but very vulnerable children, who have experienced mental health difficulties, abuse, family trauma, but sometimes those [other factors] just get whitewashed,” one female clinician said. “If someone was suggesting plastic surgery or any other permanent change we’d be saying, hang on a minute.”

“They believe that physically healthy children are being medicated in response to pressure from transgender lobby groups and parental anxieties.”

So many potentially gay children were being sent down the pathway to change gender, two of the clinicians said there was a dark joke among staff that “there would be no gay people left”.

“It feels like conversion therapy for gay children,” one male clinician said. “I frequently had cases where people started identifying as trans after months of horrendous bullying for being gay,” he told The Times.

Young lesbians considered at the bottom of the heap suddenly found they were really popular when they said they were trans.

Another female clinician said: “We heard a lot of homophobia which we felt nobody was challenging. A lot of the girls would come in and say, ‘I’m not a lesbian. I fell in love with my best girl friend but then I went online and realised I’m not a lesbian, I’m a boy. Phew.’”

Several clinicians suspected that some of the “transgender” adolescents were reacting to homophobia at home.

“For some families, it was easier to say, this is a medical problem, ‘here’s my child, please fix them!’ than dealing with a young, gay kid,” the third female clinician said. At the service’s “family days”, a parent was allegedly heard saying that they did not want their child to have gay friends because they “didn’t want them mixed up in that hedonistic lifestyle”. “It is converting people into heterosexuals,” one of the clinicians said. “We had so many families who would talk about not wanting their daughters to be lesbian.” Young people “repeatedly” confided their own “disgust” that they may be gay, according to the clinician.

“Children’s bodies are being damaged in order to treat societal issues,” she warned. She recalled a case of a 13-year-old child “whose parents were really pressurising us for puberty blockers”. When the clinician refused to refer him, she claims one of the parents, a lawyer, wrote threatening legal letters to the service. The child was eventually referred for blockers.

I list of these consequences can be found here:

She would have nightmares about her years at the Tavistock. “I would talk about it as an ‘atrocity’. I know that sounds quite strong, but it felt as if we were part of something that people would look back on in the future, and ask, what were we thinking? In the future I think there will be lots and lots of de-transitioners who feel their bodies were mutilated as young people and who will ask, why did you let me do this? It is very disturbing.”

All five clinicians expressed concern over how little young people and their families were being told about the impact of hormone treatment on fertility and sexual function as adults. One claimed young people were unable to give “informed consent” because it was regarded as taboo to discuss the impact of medical intervention on later sexual function in such a young cohort.

In what other specialism would physical intervention that leads to permanent change to the body be the first line of treatment for a vulnerable child? Activists will tell you it’s unethical not to intervene. But we know that not everyone with gender dysphoria will go on to identify as trans for the rest of their lives.”

One case has haunted her. “All the pushing was coming from the father to put the kid on puberty blockers. Thinking back on it now, I fear that the father was a paedophile and the child was being abused.” There is no suggestion the service knowingly ignored the case, and the outcome is unknown

These health professionals have differing opinions about the quality of care. The head of the clinic maintains that proper care is taking place and that there is no evidence of harm. Hopefully this assessment will turn out to be correct for the vast majority of children. But some collateral damage is likely inevitable:

The clinic, which is run by the Tavistock and Portman Foundation Trust and whose director is Polly Carmichael, says it is tracking the progress of 44 young people who began puberty blockers in 2011, and that all available evidence is discussed with families. “This is a rapidly developing field and psychosocial and medical professionals are working hard to ensure that we respond to emerging evidence in an appropriate and considered way,” a spokesman said. The growing body of international evidence showed that “thus far, there is little reported evidence of harm,” he added.

And a differing opinion:

The whole service should have been halted when the number of “transgender” cases first exploded, one of the clinicians said. “That’s the point we should have stopped because we didn’t know what we were doing. Are we a service for kids with gender dysphoria, a medical disorder? Or are we a service for ‘transgender kids’?”

One clinician said it was understandable if her former employer was defensive, saying: “If they are getting it wrong, you have to ask, are they making kids infertile by mistake? Because if they are to truly acknowledge [our concerns], then they will have to ask themselves, what the f*** have we done to thousands of children?”

We do not have open comments on the Gender Health Query website. But that doesn’t mean we aren’t interested in what you have to say. If you have a comment, blog post idea, or any other feedback, we would be interested if the information can be supported by science research, an informed opinion, real-world observations, or personal experiences. Please contact us.