Links about Autism and Gender Dysphoria

News Links

There is a known link between gender dysphoria and autism spectrum issues. Below are several links regarding this topic.

1) This is a study (Stagg 2016) confirming higher rates of ASD in trans and non-binary-identified individuals:

Results

Individuals with autism spectrum disorder (ASD) or meeting the AQ cut-off score for ASD were over-represented in both the transgender and nonbinary groups. The key variables differentiating the transgender and nonbinary groups from the cisgender group were systematising and empathy. Levels of autistic traits and cases of ASD were higher in individuals assigned female at birth than those assigned male at birth.

Conclusions

A proportion of individuals seeking help and advice about gender identity will also present autistic traits and in some cases undiagnosed autism. Lower levels of empathy, diminished theory of mind ability and literalness may impede the delivery of effective support. Clinicians treating transgender and nonbinary individuals, should also consider whether clients, especially those assigned female at birth, have an undiagnosed ASD.

2) Another study, Kuvalanka et. al, 2017, discusses the views of mothers with trans-identified ASD, children.

3) Mahfouda et. al, 2019, is a study that acknowledges high rates of mental health problems in ASD and trans-identified youth:

Abstract: Research suggests an overrepresentation of autism spectrum diagnoses (ASD) or autistic traits in gender diverse samples, particularly in children and adolescents. Using data from the GENTLE (GENder identiTy Longitudinal Experience) Cohort at the Gender Diversity Service at the Perth Children’s Hospital, the primary objective of the current retrospective chart review was to explore psychopathology and quality of life in gender diverse children with co-occurring ASD relative to gender diverse children and adolescents without ASD. The Social Responsiveness Scale (Second Edition) generates a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) score indicating a likely clinical ASD diagnosis, which was used to partition participants into two groups (indicated ASD, n = 19) (no ASD indicated, n = 60). Indicated ASD was far higher than would be expected compared to general population estimates. Indicated ASD on the Social Responsiveness Scale 2 (SRS 2) was also a significant predictor of Internalising behaviours (Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Thought Problems subscales) on the Youth Self Report. Indicated ASD was also a significant predictor of scores on all subscales of the Paediatric Quality of Life Inventory. The current findings indicate that gender diverse children and adolescents with indicated ASD comprise an especially vulnerable group that are at marked risk of mental health difficulties, particularly internalising disorders, and poor quality of life outcomes. Services working with gender diverse young people should screen for ASD, and also provide pathways to appropriate care for the commonly associated mental health difficulties.

4) There is an article in Spectrum on autism and treatment guidelines that discredits the idea their gender obsession may be due to an over-focusing problem.

“New clinical guidelines address gender dysphoria in autism”

My argument is you need to understand the normal course of gender development for people with autism first.

5) This link from Seattle Children’s Hospital reviews treatment guidelines for gender dysphoric youth with autism.

6) Aeon has an article that discusses the harmful effects of attempts to depathologize autism spectrum disorders and reframe them as “neurodiversity” and an identity-politics activist issue. There has been a very similar trend in trans discourse in the mental health profession, where trans identity is framed as a normal part of gender expression (yet requires risky cross-sex hormones and surgeries that require a diagnosis in order for insurance to cover it.)

“Against neurodiversity:”

It is, therefore, time to start thinking differently about neurodiversity, and to recognise the importance of free speech in the public discourse on autism, because if neurodiversity means anything, it means accepting that we all think differently, and that not everyone takes pride in being autistic.

7) This study is a Yale review.

“Gender Identity and Autism Spectrum Disorders:”

it is unclear whether the most fruitful way to conceptualize this issue is in terms of comorbidity. A more complex approach that attempts to understand gender in developmental terms is potentially more salient for both research and clinical purposes. Our current understanding about the unique social development of individuals with ASD, which may impact the process of gender identity formation, underlines the need for such an approach...

...an exploration of sexuality seems especially pertinent given recent findings that most children with gender-related concerns eventually identify with their natal gender following puberty and frequently adopt homosexual and bisexual identities. It is possible that individuals with ASD may experience similar trajectories in their gender narratives, but potentially follow a different timeline than normally developing individuals owing to reduced social interaction and fewer opportunities to explore their sexual identity.

8) A quote (Glidden 2016) below:

Results

The literature investigating ASD in children and adolescents with gender dysphoria showed a higher prevalence rate of ASD compared with the general population. There is a limited amount of research in adults. Only one study showed that adults attending services for gender dysphoria had increased ASD scores. Another study showed a larger proportion of adults with atypical gender identity and ASD.

9) An adult autogynephile believes AGP is a syptom of autism in this video.

“Autogynephilia is a symptom of autism, not transgender identity"

10) Mahfouda (2019) is an Australian study:

Conclusions

This study expanded on previous research to replicate the finding of higher levels of autistic traits and ASD in a clinic-referred gender diverse sample in Australia. We found that gender diverse children and adolescents with indicated ASD comprise an especially vulnerable group that are at marked risk of mental health difficulties, particularly internalising disorders, and poor quality of life. These findings should be considered when developing best practice for working with gender diverse young people with ASD to ensure that their health care meets their unique needs.

11) Leef (2019):

The results of our study showed evidence of both specificity and nonspecificity with regard to ASD traits and caseness. Future research can adopt the principle of multifinality to understand better why only a minority of children with GD have a co-occurring diagnosis of ASD, but the majority does not.

12) Dr. Strang is a major researcher in the area of autism spectrum and gender dysphoria and a pro-transition, affirmitive model advocate.

Nature and Nurture- Trans and LGB Research Update

News Links

Brain Research

Researchers (Gliske 2019) propose some new theories about the cause of gender dysphoria that goes beyond the popular “pink brain/blue brain” narrative that emphasizes cross-sex brain similarities (true in homosexual transexuals, not in autogynephilic transexuals). The term this paper uses for this is “cross-sex brain theory.” The authors point to regions in the brain relating to dissociation from the body and anxiety about the body and the networks between brain regions. This is different from the more common and simplistic view of innate brain sex. Gliske uses the term “multisense.” Below is a summation of the findings:

We hypothesize that in individuals with gender dysphoria, the aspects of chronic distress, gender atypical behavior, and incongruence between perception of gender identity and external primary sex characteristics are all directly related to functional differences in associated brain networks. We evaluated previously published neuroscience data related to these aspects and the associated functional networks, along with other relevant information. We find that the brain networks that give individuals their ownership of body parts, that influence gender typical behavior, and that are involved in chronic distress are different in individuals with and without gender dysphoria, leading to a new theory—that gender dysphoria is a sensory perception condition, an alteration in sense of gender influenced by the reflexive behavioral responses associated with each of these networks. This theory builds upon previous work that supports the relevance of the body ownership network and that questions the relevance of cerebral sexual dimorphism in regards to gender dysphoria. However, our theory uses a hierarchical executive function model to incorporate multiple reflexive factors (body ownership, gender (a)typical behavior, and chronic distress) with the cognitive, reflective process of gender identity…

After considering this hypothesis, we present a new theory of gender dysphoria, consistent with the latest neuroscience data, that stands in contrast to the common opposite brain sex theory and builds upon the work relating body perception with gender dysphoria (Burke et 112  al., 2017b; Manzouri et al., 2017; Manzouri and Savic, 2019). We denote this new theory the multisense theory of gender dysphoria. This new theory focuses on function, including sense of gender and its inputs, rather than male/female dichotomy in anatomical size and shape (the focus of the opposite brain sex theory). For clarity, in this document we use “sense of gender” to refer to the emergent sense arising from the function of multiple networks, and “brain sex” to refer to anatomical characteristics of the brain relative to male/female dichotomy. We also use the term “transgender” throughout this manuscript, though recognize that some references instead use the word transsexual to refer to the same concept. We observe, based on previously published data, that the primary mechanism behind the experience of gender dysphoria appears not to be that the anatomical brain sex is opposite to gender assigned at birth. Instead, we propose that systemic changes in functional networks, specifically the distress, social behavioral and body-ownership networks, result in the incongruence between sense of gender and gender assigned at birth.

Newsweek published an article that contains critiques of the paper’s positions and Gliske’s suggestion that there may be other alternatives to help GD beyond medical treatment. In current gender discourse, there tends to be strong pushback if any person suggests it would be a better outcome to avoid genital surgery, mastectomy, and the known negative side-effects of taking high doses of cross-sex hormones:

Simona Giordano, an expert in gender identity and Reader in Bioethics at The University of Manchester Law School, who did not work on the study, told Newsweek she was surprised Gliskesuggested altering neural structures and networks is less invasive than providing gender-affirming treatment.

Giordano also argued Gliske's suggestions for treatment would "get rid of gender incongruence," and expressed concern this amounts to a form of "medical conversion." 

While understanding the mechanisms of sexual orientation and gender identification is a "legitimate scientific effort," Giordano argued, she said "science that singles out gender minorities as subjects of study might inadvertently suggest that there is an underlying medical problem."

"Should we use these hypothetical therapies, we would no longer have gender dysphoria sufferers because we would no longer have transgender people," she said.  

Giordano highlighted that various international organizations, such as UNESCO, and the Council of Europe, have called de-pathologization of gender diversity. Last year, the World Health Organisationrenamed gender identity disorder as gender incongruence to "reflect the international consensus that gender diversity is not a disorder or illness," she said.

Professor Catherina Becker, acting director of the Centre for Discovery Brain Sciences at the U.K.'s University of Edinburgh, who did not work on the paper, also critiqued the work. She commented in a statement: "The present paper is a review and reinterpretation of other studies without providing significant new experimental or epidemiological data.

Here are two other articles from The Daily Mail and Inverse.

Biological Factors in In Identity & Orientation

A new study (Nila, 2019) confirms the fraternal birth order (FBO) effect noted in homosexual males in an Indonesian population:

Abstract

Male homosexual preference (MHP) is an evolutionary enigma because it is partially heritable and imposes a fertility cost. In occidental societies, homosexual men are feminized at various levels and they have more older brothers than heterosexual men. To evaluate whether femininity and the fraternal birth order (FBO) effect are universal features of MHP or not, we collected original data from homosexual men, heterosexual men, and heterosexual women from Java (Indonesia). Facial photographs were used to test whether homosexual faces are feminized when compared with heterosexual ones. We found that faces manipulated to resemble the average face of homosexual men are perceived as facially feminized, suggesting that homosexual men are facially feminized compared to heterosexual men, although a higher facial femininity was not captured by morphological analyses. Then, family data were used to detect differences in siblings’ composition between homosexuals and heterosexuals. Homosexual men displayed a higher number of older brothers than heterosexual men, even when sibship size was controlled for, suggesting that the FBO effect exists in Indonesian populations. Independent of sexual orientation, men with older brothers seem more feminized than those without older brothers, consistent with the immune origin of the FBO effect. In conclusion, MHP in Indonesia is partially feminized and they have more older brothers. Such features are also associated with MHP in other cultural contexts, suggesting a cross-cultural effect of men homosexual preference. An evolutionary explanation is available for the feminizing effect, although the FBO effect remains unexplained even if proximal mechanisms start to be identified.

A new study (Rahman 2019) reviewing the populations of lesbian, gay, and bisexual people in various countries supports arguments for innate sexual orientation:

Abstract

The prevalence of women’s and men’s heterosexuality, bisexuality, and homosexuality was assessed in 28 nations using data from 191,088 participants from a 2005 BBC Internet survey. Sexual orientation was measured in terms of both self-reported sexual identity and self-reported degree of same-sex attraction. Multilevel modeling analyses revealed that nations’ degrees of gender equality, economic development, and individualism were not significantly associated with men’s or women’s sexual orientation rates across nations. These models controlled for individual-level covariates including age and education level, and nation-level covariates including religion and national sex ratios. Robustness checks included inspecting the confidence intervals for meaningful associations, and further analyses using complete-cases and summary scores of the national indices. These analyses produced the same non-significant results. The relatively stable rates of heterosexuality, bisexuality, and homosexuality observed across nations for both women and men suggest that non-social factors likely may underlie much variation in human sexual orientation. These results do not support frequently offered hypotheses that sexual orientation differences are related to gendered social norms across societies.

A quote from the article appears to show possible cultural influence on whether or not men will identify as gay and there is more variability in countries around women and bisexuality:

However, prevalence rates of men’s homosexual identity were more variable, across nations, than prevalence rates of women’s lesbian identity, p = .009. When sexual orientation was assessed in terms of participants’ same-sex attraction, women were more variable than men, across nations, in their prevalence of being moderately attracted to the same sex, p < .004. However, women and men did not differ significantly in the variability of their prevalence of not being attracted to the same sex and being predominantly attracted to the same sex (all ps > .05).

There appear to be more gay men than lesbians but more bisexual females than bisexual males:

However, a higher percent of men (4.9%) than women (2.1%) reported a homosexual identity, t(54) = 5.22, p < .001, whereas a lower percent of men (5.1%) than women (7.2%) reported a bisexual identity, t(54) = − 3.25, p = .002

In summary:

Finally, the relatively small cross-nation SDs reported in Table 4—particularly for prevalence rates for homosexual identities and predominant same-sex attractions—suggest substantial consistency across nations. Thus, despite the existence of variations across nations, sexual orientation rates were nonetheless relatively stable across nations.

A study on feminine Samoan males (called fa ‘afafina) reveals men who have sex with feminine (intact) males display a variety of orientation patterns from bisexual to primarily homosexual or heterosexual. This shows that these men are a diverse group. Ray Blanchard, a gender dysphoria expert and psychologist, coined the term gynoandromorphalia for males who are interested in trans MtFs or cross-dressing males. But it appears this may be a diverse group:

Abstract

In Samoa, feminine natal males who possess male-typical genitalia are known locally as fa’afafine. Some Samoan men express sexual interest in fa’afafine, whereas others do not. To assess the sexual orientation of men who are sexually interested in fa’afafine, we collected sexual attraction ratings and viewing times of Samoan men’s and women’s faces. Study 1 (N = 130) focused on men who were insertive or versatile during anal sex with fa’afafine partners. These men were compared to each other, as well as to males (i.e., men and fa’afafine) who were exclusively sexually interested in either women or men. Study 2 (N = 180) compared men who had sex with fa’afafine and women; men who had sex with fa’afafine, women, and men; and men who had sex with fa’afafine and men. These men were compared to each other, as well as to males who were exclusively sexually interested in either women or men. These studies suggest that men who have sex with fa’afafine are a heterogeneous group. A small portion of the men who are sexually interested in fa’afafine shows a relatively bisexual pattern of sexual attraction ratings and viewing times, namely men who have sex with fa’afafine, men, and women. In contrast, a larger number of men who were sexually interested in fa’afafine responded in a manner similar to men who were exclusively sexually interested in either women or men. The present research suggests that additional insights into male sexual orientation can be garnered by focusing on how sexuality is expressed in non-Western cultural contexts.

Social Contagion

GHQ reviews the large rise in young people identifying as trans in Topic 10 and Topic 11. A parent group called the Kelsey Coalition made a post reviewing some more recent statistics concerning the large increases of trans-identification in teenagers:

-In Oregon, 6% of 8th graders and 5.5% of 11th graders identify as transgender or non-binary. 2019 Oregon Health Teens Survey. 

-In Hawaii, over 3% of over 38,000 public high school students surveyed identify as transgender. Hawaii Sexual and Gender Minority Health Report (2018):

-2% of Minnesota 8th grade girls identify as transgender, while an additional 3% were not sure. Minnesota 2019 Student Survey

-Among Wisconsin high school students, 1% identified as non-binary, 1% as gender fluid, 1% as transgender, and 2% were not sure. Dane County, Wisconsin Youth Assessment Survey, 9th-12th Grade Report (2018). Among Wisconsin middle school students, 2% identify as non-binary, 1% as transgender, and 3% were nv County, Wisconsin Youth Assessment Survey, 7th-8th Grade Report (2018).

-Surveys of Maine high school students found 1.5% identify as transgender and 1.6% of students were unsure of their gender identification. Maine Integrated Youth Health Survey (2017)

This paper reviews the data indicating a major increase in trans-identified young people in Nordic countries:

Abstract

Purpose: To explore whether the increase observed in referrals to child and adolescent gender identity services (GIDSs) has been similar in four Nordic countries and in the UK.

Materials and methods: Numbers of referrals per year in 2011–2017 were obtained from all GIDS in Denmark, Finland, Norway, Sweden and the UK and related to population aged <18.

Results: A similar pattern of increase in referral rates was observed across countries, resulting in comparable population adjusted rates in 2017. In children, male:female birth sex ratio was even; in adolescents, a preponderance of females (birth sex) was observed, particularly in Finland.

Conclusions: The demand for GIDSs has evolved similarly across Nordic countries and the UK. The reasons for the increase are not known but increased awareness of gender identity issues, service availability, destigmatization as well as social and media influences may play a role.

Body dysmorphia around gender isn’t the only body dysmorphia increasing rapidly. More you females are seeking labiaplasty surgery:

Dr Naomi Crouch, a leading adolescent gynaecologist, said she was concerned GPs were referring rising numbers of young girls who wanted an operation.

Labiaplasty, as the surgery is known, involves the lips of the vagina being shortened or reshaped.

The NHS says it should not be carried out on girls before they turn 18.

In 2015-16, more than 200 girls under 18 had labiaplasty on the NHS. More than 150 of the girls were under 15…

Anna - not her real name - considered having labiaplasty from the age of 14.

"I just picked up from somewhere that it wasn't neat enough or tidy enough and I think I wanted it to be smaller.

"People around me were watching porn and I just had this idea that it should be symmetrical and not sticking out.

"I thought that was what everyone else looked like, because I hadn't seen any normal everyday [images] before then.

"I remember thinking, 'If there's surgery for it, then clearly I'm not the only one who wants this done, and maybe it won't be that big a deal.'."

References

Gander, K. (2019, December 12). Transgender People Suffering From Gender Dyphoria May Have Key Brain Differences, Scientist Says. Newsweek. Retrieved from https://www.newsweek.com/transgender-people-gender-dysphoria-brain-differences-scientist-1475013

Kaitiala, R, Bergman, H., Carmichael, P., de Graaf, N., Rischel, K., Frisen, L. (2019). Time trends in referrals to child and adolescent gender identity services: a study in four Nordic countries and in the UK.

Mackenzie, J. (2017, July 3). Vagina surgery 'sought by girls as young as nine.' BBC. Retrieved from https://www.bbc.com/news/health-40410459

Nila, S., Crochet, P., Barthes, J., Rianti, P., Juliandi, B., Suryobroto, B., Raymond, M. (2019). Male Homosexual Preference: Femininity and the Older Brother Effect in Indonesia. Evolutionary Psychology. doi.org/10.1177/1474704919880701

Petterson, J. L., Dixson, B.J., Little, A. C. (2020). Heterogeneity in the Sexual Orientations of Men Who Have Sex with Fa’afafine in Samoa. Archives of Sexual Behavior, 1-13. https://doi.org/10.1007/s10508-020-01646-6

Rahman, Q., Xu, Y., Lippa, R.A. et al. (2019). Prevalence of Sexual Orientation Across 28 Nations and Its Association with Gender Equality, Economic Development, and Individualism. Archives of Sex Behavior, 1-12 doi.org/10.1007/s10508-019-01590-0

Gender Dysphoria and Other Mental Health Issues are Rising in Teens

News

This post will add information about the rising rates of gender dysphoria and other mental health issues.

Recent Trans Mental Health Studies Criticized

Michael Biggs has been criticizing a study involving giving puberty blockers to tweens/teens, Costa (2015), that claims puberty blockers are psychologically beneficial. This study is from the Gender Identity Services (GIDS) in Britain, and Biggs writes the benefits to the patients may be exaggerated by the researchers:

RESULTS

At baseline, GD adolescents showed poor functioning with a CGAS mean score of 57.7 ± 12.3. GD adolescents' global functioning improved significantly after 6 months of psychological support (CGAS mean score: 60.7 ± 12.5; P < 0.001). Moreover, GD adolescents receiving also puberty suppression had significantly better psychosocial functioning after 12 months of GnRHa (67.4 ± 13.9) compared with when they had received only psychological support (60.9 ± 12.2, P = 0.001).

CONCLUSION: 

Psychological support and puberty suppression were both associated with an improved global psychosocial functioning in GD adolescents. Both these interventions may be considered effective in the clinical management of psychosocial functioning difficulties in GD adolescents.

He has published a letter about the Costa study stating the claim that blockers are beneficial is suspect.

“A Letter to the Editor Regarding the Original Article by Costa et al: Psychological Support, Puberty Suppression, and Psychosocial Functioning in Adolescents with Gender Dysphoria:”

He wrote another article about puberty blockers and the adverse effects on bone health which the researchers in the study also appear to downplay.

A Swedish study about trans people has been published using data from the registered Swedish public. This a beneficial longitudinal survey from an estimated 95% of their population. The study finds trans people have much higher rates for mental health problems and suicide risk.

“Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study:”

Results:

Compared with the general population, individuals with a gender incongruence diagnosis were about six times as likely to have had a mood and anxiety disorder health care visit, more than three times as likely to have received prescriptions for antidepressants and anxiolytics, and more than six times as likely to have been hospitalized after a suicide attempt. Years since initiating hormone treatment was not significantly related to likelihood of mental health treatment (adjusted odds ratio=1.01, 95% CI=0.98, 1.03)…

But they state that with more time past medical transition attempts to access mental health services goes down. They say in the study this justifies medical transition: UPDATE: THE AMERICAN JOURNAL OF PSYCHIATRY NOW STATES THE DATA DOES NOT INDICATE SURGERY IMPROVES MENTAL HEALTH AND HAS ISSUED CORRECTIONS AFTER MULTIPLE LETTERS TO THE EDITOR EXPOSING THE STUDY’S FLAWS

However, increased time since last gender-affirming surgery was associated with reduced mental health treatment (adjusted odds ratio=0.92, 95% CI=0.87, 0.98).

Conclusions:

In this first total population study of transgender individuals with a gender incongruence diagnosis, the longitudinal association between gender-affirming surgery and reduced likelihood of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them.

Mark Regenerus is a researcher out of the University of Austin who appears to have an anti-homosexual/bisexual bias. He wrote a much-criticized study that claims children of LGB parents do poorly and filed an amicus brief against same-sex marriage in federal court. Almost all research on children of gay or lesbian couples over the last several decades shows that children in gay/lesbian households do as well as other children. The study lumped in any single parent, divorced parent, or those with transient same-sex experiences all in together. This isn’t a comparison with a two parent home. The study was also criticized for sloppy data gathering and analysis. Criticism of Regnerus may be found here and the story was covered in the Washington Post and elsewhere. Due to this track record, GHQ corroborated his claims about the Swedish study.

Regnerus explains the data gathered in the study is very sound:

This is as good as it gets when it comes to studying transgender medical experiences and outcomes.

Like Biggs, Regnerus states the researchers’ claims of benefit of medical transition are inflated:

Data from a new study show that the beneficial effect of surgery for transgender people is so small that a clinic may have to perform as many as 49 gender-affirming surgeries before they could expect to prevent one additional person from seeking subsequent mental health treatment. Yet that’s not what the authors say. That the authors corrupted otherwise-excellent data and analyses with a skewed interpretation signals an abandonment of scientific rigor and reason in favor of complicity with activist groups seeking to normalize infertility-inducing and permanently disfiguring surgeries…

First, a word about the hormones: the study found no mental health benefits for hormonal interventions in this population. There is no effect of time since initiating hormone treatment on the likelihood of subsequently receiving mental health treatment. Given the surge in interest, demand, and supply of hormonal therapies to self-identified transgender persons today, you would think that it is a solution that pays obvious benefits in reduced subsequent need—over time—for treatment of mood or anxiety disorder, or hospitalization after a suicide attempt. Yet there was no statistically significant effect. In fact, the confidence intervals actually reveal a nearly significant aggravating effect of hormonal treatment on subsequent mental health needs.

It is the surgical effect, however, that has grabbed all the attention. Bränström and Pachankis detected a statistically significant effect of time since last “gender-affirming” surgery on reduced mental health treatment. The adjusted (for controls) odds ratio for this was 0.92, meaning that, among respondents diagnosed with “gender incongruence” who then received gender-affirming surgical treatment, the odds of being treated for a mood or anxiety disorder (in 2015) were reduced by about 8 percent for each year since the last surgery. In other words, it would appear that the surgery—or more typically, the series of surgeries—benefited their mental health.

The numbers are crunched here:

But the authors discuss a “linear decrease” in seeking subsequent mental health care that is simply not visible in the study’s graphs, where post-surgical mental health treatment hovers stably around 35 percent among those in their first nine years after surgery, and then drops to only 21 percent of those patients who are in their tenth (or higher) year since their last surgery. However, only 19 total respondents reported their last surgery as having been completed 10 or more years ago. By contrast, 574 (out of 1,018 total) reported their last surgery as having been conducted less than two years ago. (Surgical treatment is clearly surging.) This means that the apparently helpful overall effect of surgery is driven by this comparatively steep drop in mood/anxiety treatment among only 19 patients. By the math, that would seem to indicate that four out of these 19 Swedes (i.e., 21 percent) sought help in 2015 for mood/anxiety problems.

While the study reports the adjusted odds ratio of the overall effect of time since surgery (0.92), which I cannot replicate without having data access, you don’t need the data to calculate an unadjusted odds ratio from the information presented there. This can tell us the baseline effect of time since surgery on receiving mood and anxiety treatment, only without the controls (like age, income, etc.). Doing this reveals the fragility of the study’s key finding: if a mere three additional cases among these 19 had sought mental health treatment in 2015, there would appear to be no discernible overall effect of surgery on subsequent mental health. The study’s trumpeted conclusion may hinge on as few as three people in a data collection effort reaching 9.7 million Swedes, 2,679 of whom were diagnosed with gender incongruence and just over 1,000 of whom had gender-affirming surgery…

Another helpful statistic I calculated is called the NNT, or “Number Needed to Treat.” It’s a measure of clinical impact. In this study, the NNT appears to be a staggering 49, meaning the beneficial effect of surgery is so small that a clinic may have to perform 49 gender-affirming surgeries before they could expect to prevent one additional person from seeking subsequent mental health assistance 1. If no other treatment was available, or the treatment was not invasive and the hazards were insignificant, clinics might consider surgery a low-risk but low-payoff approach. But none of those applies here. Conducting 49 surgeries to secure one additional patient who benefits? Unheard of.

He goes on to criticize the optimistic interpretation of the research as justification for risky medical treatments:

Physicians should not be pushed to prescribe such profoundly consequential treatment by threat of call-out, malpractice suits, patient demand, or—in this case—the overreaching interpretations of quality data. Clinicians are being bullied into writing a radical prescription based on fear, not on sensible conclusions from empirical data…

This is not how normal medical research works.

He also criticizes a study on conversion therapy and suicidality here. He argues the framing was sloppy and conclusions overconfident.

First…

Psychiatrist and longtime gender identity expert Stephen Levine highlights the quandary facing professionals attempting to counsel transgender patients on the biological, social, and psychological risks posed by any treatment approach. Such risks are real and ought to be discussed. This is what ethical informed consent does. But in the USTS survey lingo, an ethical discussion of risk could be interpreted by the patient as “trying to stop you being trans.” In other words, obtaining informed consent may constitute GICE…

Second, the data come from a nonrandom, opt-in survey—the USTS—that only targeted networked, self-identified transgender or nonbinary persons by advertising their survey among “active transgender, LGBTQ, and allied organizations.” There’s nothing wrong with collecting data using a nonrandom approach like this—I’ve done it myself and will do it again. The problem is when such data are delivered to the reader, as these were, in a way that suggests the conclusions would be consonant with everyone who has identified as transgender or experienced gender identity disorder or dysphoria…

Third, building on the dubious perception of representativeness, the authors report “confidence intervals” for their statistical “estimates.” Why they do so is beyond me. It’s a charade.

Fourth, the authors seem largely uninterested in putting their implied causation—that past conversion attempts affect present mood and suicidality—to the test. Instead, a subtext of injustices committed against the respondents infuses the study, suggesting a decidedly external locus of control in the lives of transgender Americans…

Trans Youth, Mental Health, and Suicide Risk

*Suicide ideation is socially contagious in young people and caution in reporting is warranted to not sensationalize it or make things appear hopeless to troubled people. If you or someone you know is struggling with depression or has had thoughts of harming themselves or taking their own life, there's help for you and hope. The National Suicide Prevention Lifeline (1-800-273-8255) provides 24/7, free, confidential support for people in distress, as well as best practices for professionals and resources to aid in prevention and crisis situations.

GHQ strives to cover the issue of suicide risk as objectively as possible, and we never advocate shunning a transgender youth or minimizing their distress. One can find an objective review of the data around trans people and suicide risk in Topic 15 and a summary here.

A case study of a youth who attempted suicide despite a supportive environment provides salient quotes about current trans demographics:

Gender dysphoria (GD) among adolescents is not uncommon. A recent survey among high school students found that 1.2-2.7% considered themselves transgender or uncertain of gender [1-2]. Reports also suggest an increasing number of adolescents referred to specialized gender identity clinical services for the treatment of gender dysphoria [3]. Any clinician who cares for young patients should be well informed of the impact gender dysphoria and related treatments have on mental health. Awareness of the increased prevalence of depression, anxiety, and suicidal ideation among these individuals can prepare healthcare providers to anticipate and respond appropriately to their presentation.

A 2017 chart review from a transgender clinic in Cincinnati found that among youth aged 12-22 with a diagnosis of gender dysphoria, 58% had another psychiatric diagnosis, and 30.3% reported at least one suicide attempt [4]. Two similar studies support these findings, with attempted suicide rates of 31% and 26% among transgender or gender dysphoric adolescents [2, 5].

Recent cohorts of trans-identified youth seem to focus on weight issues heavily:

Discussion

While the long-term outcome of this patient remains to be seen, this is a significant example of the psychiatric complexity of gender dysphoria. Despite outpatient treatment and supportive family, this patient suffered from persistent suicidal ideation. The repeated expressions of extreme dissatisfaction with appearance were notable. It has been found that among transgender youth, a significantly greater proportion of those who had attempted suicide expressed weight-related body dissatisfaction than those who had not. They also had a higher rate of negative assessment by others of appearance [5]. More recently, another study confirmed a significant correlation between suicidality and a desire for weight change among adolescents with gender dysphoria [4]. There has long been a natural association between body dissatisfaction and gender dysphoria; however, these reports and this case highlight the importance of assessing the degree and characterization of body dissatisfaction as they may contribute to suicidal risk.

Just for perspective, several studies on the overall declining mental health and an increase in suicide risk in teens and young adults are included here:

Business Insider

Suicide rate for people aged 10 to 24 increased by 56% between 2007 to 2017, according to new data from the CDC.

-For children aged 10 to 14, the suicide rate tripled between 2007 to 2017 after years of decline.

-Suicide had increased among millennials, but the data suggests Gen Z might be most at risk for mental illness.

Social media seems to be a reason many people believe is a factor since the rise of it coincides with these increases:

Social media might be fueling the increase in mental illness, as Gen Z is the first truly digital generation. Pew Research Center found 45% of teens aged 13 to 17 said they use the internet "almost constantly." Over-use of social media can cause loneliness, depression, and anxiety, the Anxiety and Depression Association of America reported.

“Are Mental Health Disorder Rates in Youth Really Increasing?”

A 2019 Gallup poll found that sadness, anger, and fear have risen for the second consecutive year around the world.

However, it is also true that we’ve experienced a burgeoning of resources, the highest education rates ever in the country’s history, and an overall decreasing violent crime rate. The same innovations that are said to be isolating also allow us to express ourselves, connect with others around the world, and stay informed. Steven Pinker, a professor of psychology at Harvard University, showed that despite the bleak worldview of the 24/7 news cycle, many metrics reveal that we are living in the most peaceful time in human history.

A Rolling Stone article emphasizes the need to provide youth with support and hope:

That said, research does indicate that early intervention in the form of initiatives like suicide screening at emergency rooms and pediatricians’ offices does play a role in helping to prevent suicide, as does exposure to positive stories about people recovering from feelings of suicidal ideation. Which is why it’s important to interpret the CDC’s finding not as cause for panic or rampant speculation, but as a call for heightened awareness for teens who may be at increased risk.

Johnathan Haidt, the author of Coddling of the American Mind, discusses these increases in mental health problems. He also notes the fact that females are most at risk and offers some suggestions about how to approach this issue:

In 2018 Micheal Biggs (mentioned earlier) wrote an article about these increases affecting girls disproportionately when it comes to gender dysphoria for 4thwavenow (“A community of parents & others questioning the medicalization of gender-atypical youth”):

Micheal Biggs/4thwavenow: “Attempted suicide by American LGBT adolescents”

The graph above shows the estimated odds of a student reporting attempted suicide, compared to heterosexual boys. As the Advocate emphasized, teens who identified as female-to-male transgender had the highest risk of attempted suicide; the odds were four times higher than for heterosexual boys. What went unnoticed is that the risk was just as high for bisexual girls.

The next highest rates (triple the odds compared to heterosexual boys) were for bisexual boys, lesbian girls and for kids who identified as nonbinary. The latter’s sex was not recorded, but the majority are likely to be female; other survey evidence suggests that two-thirds of trans-identified adolescents are female (Eisenberg et al. 2017).

The next highest rates (roughly double the odds for heterosexual boys) were for gay boys, for male-to-female transgender kids, and for kids who were unsure of their gender identity (whose sex was not recorded). Finally, heterosexual girls had a significantly higher risk than heterosexual boys.

Stephanie Davies-Arai and Nic Williams’ critique of Stonewall’s School Report suggested that “[t]he ‘transgender’ category may just serve to cover up the scale of suicide attempts and self-harm rates of girls and young women.” Their conjecture is vindicated by this survey evidence from the United States.

“Reason Lost to Suicide in Trans Debate” is an article that lays out the politicization of the suicide issue in the debate around pediatric medical transition. There is increased suicide risk in dysphoric young people and at the same time this is often exaggerated and used to get the public to comply with activist demands:

Also troubling is the activist mantra that kids will kill themselves if the trans project encounters any obstacle, personal or political. Lil­lian says: “I don’t understand why this one mental health condition is the exception to international best practice around how we talk about suicide.” Some suicide appears contagious, hence the well-known advice: don’t harp on the risk for a specific group, don’t imply taking your life is a default option, don’t catastrophise setbacks, don’t oversimplify the causes of suicide. Activists rediscover the risk of suicide contagion when they misrepresent media coverage that questions their narrative.

This is an older survey but is included here for its interesting conclusion that people with alternative identities such as nonbinary and FtM are at greater risk for sexual assault:

ustranssurvey.org

ustranssurvey.org

There is a strong push to stop trans identity and gender dysphoria itself from being defined as a mental illness by trans activists and some doctors who provide trans healthcare. An example is provided by Dr. Micheal Frist and Dr. Jack Drescher who want it redefined in the next ICD-11 (“International Classification of Diseases”) and the DSM (a mental health diagnostic manual). They want it defined as a type of physical body defect that needs to be corrected and thus defined purely as a medical issue.

In the below screencap, Dr. Ray Blanchard mentions theories relating gender dysphoria to other body dysmorphias and paraphilias. He asks if those who have made this connection would argue for the same thing to apply to these other conditions. He is demonstrating that trans identity is politicized in ways other body dysmorphias aren’t:

@BlanchardPhD

References:

Attempted suicide by American LGBT adolescents. (2018, October 28). Retrieved from https://4thwavenow.com/2018/10/23/attempted-suicide-by-american-lgbt-adolescents/

Biggs, M. (2019). A Letter to the Editor Regarding the Original Article by Costa et al: Psychological Support, Puberty Suppression, and Psychosocial Functioning in Adolescents with Gender Dysphoria. The Journal of Sexual Medicine 16(12) 2043. doi.org/10.1016/j.jsxm.2019.09.002

Biggs, M. (2019, July 29). The Tavistock’s Experiment with Puberty Blockers. Department of Sociology and St Cross College, University of Oxford. Retrieved from http://users.ox.ac.uk/~sfos0060/Biggs_ExperimentPubertyBlockers.pdf

Bränström, R., Pachankis, J.E. (2019). Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study. The American Journal of Psychiatry. doi.org/10.1176/appi.ajp.2019.19010080

D. Carpenter. (2015, May 10). A “reality check” for the Regnerus study on gay parenting [UPDATED]. The Washington Post. Retrieved from https://www.washingtonpost.com/news/volokh-conspiracy/wp/2015/05/10/new-criticism-of-regnerus-study-on-parenting-study/

Cheng, S., Powell, B. (2015). Measurement, methods, and divergent patterns: Reassessing the effects of same-sex parents. Social Science Research 52, 615-626. doi.org/10.1016/j.ssresearch.2015.04.005

Costa, R., Dunsford, M., Skagerberg, E, Holt, V., Carmichael, P., Colizzi, M. (2015). Psychological Support, Puberty Suppression, and Psychosocial Functioning in Adolescents with Gender Dysphoria. The Journal of Sexual Medicine 12(11), 2206 - 2214. doi.org/10.1111/jsm.13034

Day, D.S., Saunders, J.J., Matorin, A. (2019). Gender Dysphoria and Suicidal Ideation: Clinical Observations from a Psychiatric Emergency Service. Cureus. doi: 10.7759/cureus.6132

Dickson, E. (2019 October 18). Teen Suicide Is on the Rise and No One Knows Why. Rolling Stone. Retrieved from https://www.rollingstone.com/culture/culture-news/teen-suicide-study-increase-why-900711/?fbclid=IwAR0PUvjFbmcal-fZ4easCS266R37otmCguB-9T1gulKCylWnJTWNkWBag-M

Baiocco, R., Carone, N., Ioverno, S., Lingiardi, V. (2018). Same-Sex and Different-Sex Parent Families in Italy. Journal of Developmental & Behavioral Pediatrics 39(7). 555–563. doi: 10.1097/DBP.0000000000000583

Haidt, J. (n.d.). How to improve mental health using ideas from the book. The Coddling. Retrieved from https://www.thecoddling.com/better-mental-health

Kiersz, A., Akhtar, A. (2019, October 17). Suicide is Gen Z's second-leading cause of death, and it's a worse epidemic than anything millennials faced at that age. Business Insider. Retrieved from https://www.businessinsider.com/cdc-teenage-gen-z-american-suicide-epidemic?fbclid=IwAR0xFdMxxECTrJFnyKpSjUAxS8f6rq44ITk6LE7Pc0ooxEGcsnv-ZqrZnmk&utm_campaign=sf-insider-main&utm_medium=social&utm_source=facebook.com

Lane, B. (2019, November 2). Reason Lost to Suicide in Trans Debate. The Australian. Retrieved from https://www.theaustralian.com.au/inquirer/reason-lost-to-suicide-in-trans-debate/news-story/af31e3357a4ec08f9a3e91227b3424bf

Noam, G. (2019, November, 7). Are Mental Health Disorder Rates in Youth Really Increasing? Psychology Today. Retrieved from https://www.psychologytoday.com/us/blog/the-inner-life-students/201911/are-mental-health-disorder-rates-in-youth-really-increasing

Regnerus, M. (2019, September 18). Does “Conversion Therapy” Hurt People Who Identify as Transgender? The New JAMA Psychiatry Study Cannot Tell Us. Public Discourse. Retrieved from https://www.thepublicdiscourse.com/2019/09/57145/

Regnerus, M. (2015). How different are the adult children of parents who have same-sex relationships? Findings from the New Family Structures Study. Social Science Research 41(4). 752-770. doi.org/10.1016/j.ssresearch.2012.03.009

Regnerus, M. (2019, November 13). New Data Show “Gender-Affirming” Surgery Doesn’t Really Improve Mental Health. So Why Are the Study’s Authors Saying It Does? Public Discourse. Retrieved from https://www.thepublicdiscourse.com/2019/11/58371/

The Rocky Road to Removing Gender Dysphoria from DSM-5. (2019, November 1). Retrieved from https://newyorkcomingout.org/events/event/the-rocky-road-to-removing-gender-dysphoria-from-dsm-5

The Report from the 2015 U.S. Transgender Survey. (2015). Retrieved from http://www.ustranssurvey.org

Turban J.L., Beckwith N., Reisner S.L., Keuroghlian A.S. (2019). Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults. JAMA Psychiatry(11), 1-9. doi:10.1001/jamapsychiatry.2019.2285

Articles: Nature and Nurture- Causes of Trans Identity and Sexual Orientation

News

On the GHQ website, Topic 10 ( NATURE VERSUS NURTURE: WHAT OTHER FACTORS BESIDES “INNATE GENDER IDENTITY” CONTRIBUTE TO TRANS IDENTIFICATION IN YOUNG PEOPLE) reviews the research that addresses biological and environmental factors in the formation of trans and LGB identities. We are updating our site with new articles and research addressing these issues.

*Blog posts updating relevant information regarding our 17 “Topics” are linked at the end of each topic to keep our site updated with the newest information to aid anyone who may be researching these subject matters.

Social Contagion

An article titled “Culture-Bound Syndromes: Satanic Panics, Multiple Personality Disorder & ROGD” on the website Areo discusses mental health issues and social contagions. GHQ covers this same subject in Topic 11, providing a long list of examples of social contagions, most involving female teens and young adults. This may be relevant to the large increases of female trans-identified teenagers.

The author, Louise Perry, first reviews the rise is diagnoses of MPD/DID (multiple personality disorder):

MPD/DID was a psychiatric phenomenon that appeared suddenly in the 1970s, following the release of Sybil, a book (and later a film) that portrayed a woman who had developed multiple personalities as a result of childhood trauma. Within a short time, the condition became astonishingly well known. More people were diagnosed with MPD/DID in the five years prior to 1986 than in the preceding two centuries. But then, just as suddenly, it disappeared.

Perry also covers the “Satanic panic” child cult-ritual sexual abuse scandals that started in the 1980s. A lot of damage happened due to false accusations and therapists were implicated in leading children on:

Satanic panic created an antagonistic binary, which still persists to this day, between those who believed in the existence of the cults, and those who didn’t. It was perversely difficult to adopt a position somewhere in between—to suggest, for instance, that, although the apparent cult victims had experienced sexual abuse, which had caused them long-term trauma, the satanic elements of their accounts were likely exaggerated or invented, the result of social contagion.

Diane Ehernsaft, one of the most aggressive supporters of the affirmative model in treating gender-dysphoric children/teens, was involved in reviewing claims by children of satanic sex abuse. She published a paper in 1992 covering this matter.

Perry describes the social contagions as “culture-bound syndromes” and provides several more historical examples of psychic epidemics to add to a long list covered on the GHQ website here.

We can now see, with the benefit of hindsight, that MPD/DID is an example of a culture-bound syndrome, an anthropological term for a psychiatric condition that is unique to one culture and historical time period. Examples from other parts of the world include Amok, a condition found in Malaysia, in which sufferers are understood to suddenly become extremely violent towards anyone in their immediate vicinity, having never previously shown signs of aggression. Another well-studied example is Dhat, a condition of the Indian sub-continent, in which men report physical weakness and impotence as a result of semen supposedly leaking out of their bodies when they urinate. Culture-bound syndromes have long been a source of fascination for anthropologists, as they often highlight crucial cultural differences in understandings of the relationship between mind and body. 

Such conditions are to be found in the western world too, although they may be harder for westerners to identify. Edward Shorter is a historian of psychosomatic illnesses, who has studied the psychiatric conditions of nineteenth-century Europe, including hysteria and neurasthenia, which fit the profile for culture-bound syndromes.

The author describes the relationship between suggestibility of these new diagnoses and Borderline Personality Disorder. BPD is known for identity instability and emotional dysregulation:

It is now known that patients diagnosed with MPD/DID are clinically indistinguishable from those diagnosed with Borderline Personality Disorder (BPD). This condition is characterised by emotional volatility, propensity to self harm, extreme vulnerability to negative emotions and difficulty in maintaining stable relationships. It is mostly found in women: it seems that men with similar tendencies are more likely to manifest Antisocial Personality Disorder.

This is relevant to the discussion of gender dysphoria because some GD mental health professionals are reporting a large number of females with BPD presenting to gender clinics. Aydin Olson, an affirmative model advocate, discussed this at a Gender Odysee conference in 2017. An anonymous source has told GHQ the same thing about a gender clinic in the central United States.

Perry then discusses “Rapid Onset Gender Dysphoria” which describes teens coming out as trans despite not expressing GD in childhood and studied by Lisa Littman. Affirmative model advocates and trans activists have strongly condemned the concept as the article points out. But there have been clusters of trans-identified teens in numbers unheard of in the past:

Aside from MPD/DID, there are a number of conditions recognised by contemporary Western psychiatry that seem to fit the culture-bound syndrome model. Anorexia nervosa is one example that has been a source of interest to anthropologists, and so-called Rapid Onset Gender Dysphoria (ROGD) is another—more controversial—possibility that has only recently emerged…

She [Littman] found that a large proportion of these young people had announced their intention to transition suddenly, out of the blue, having previously shown no signs of cross-sex identification. Littman also notes that:

​”The expected prevalence of transgender young adult individuals is 0.7%. Yet, more than a third of the friendship groups described in this study had 50% or more of the AYAs [adolescents and young adults] in the group becoming transgender-identified in a similar time frame, a localized increase to more than 70 times the expected prevalence rate”…

Other researchers have expressed support for Littman’s conclusions, among them Ray Blanchard and Kenneth Zucker, two of the leading experts on the treatment of Gender Identity Disorder. Moreover both Blanchard and Zucker have explicitly compared ROGD with MPD/DID. Some of the similarities are indeed arresting. Both the trans movement and the MPD/DID movement arose suddenly, although the groundwork had been laid over a long preceding period. Both saw a huge spike in diagnoses among young, vulnerable females. Both made extreme claims about the nature of identity, which seemed to defy conventional wisdom. Both were (and continue to be) politically charged, with an established dichotomy between goodies who are on the side of suffering victims, and baddies who refuse to accept those victims’ accounts of themselves.

Perry cautions the mental health profession not to promote potentially harmful fads:

Hence, patients unconsciously draw from what Shorter terms “the symptom pool”—the limited array of symptoms that are considered credible, not only by medical professionals, but by other members of a given society. For young women in nineteenth-century Vienna, this might mean sudden limb paralysis. For their counterparts in 1980s America, manifesting MPD/DID was a far more acceptable way of expressing trauma. Dogmatic therapists, who were convinced not only that MPD/DID was a real condition, but also that it was far more common than anyone else realised, subtly encouraged their patients to manifest the symptoms. Allen J. Frances, chair of the group who put together the fourth edition of the DSM, at the height of the MPD/DID phenomenon, writes now that the role of social contagion is indisputable…

However, we must be vigilant against the potential harms of psychiatric phenomena that offer false certainty to vulnerable people. Fear of causing offence should not be a barrier to rigorous research, particularly when patients are considering undergoing irreversible medical interventions. It is not kind to promote such conditions without evidence, nor is itcruel to be sceptical of them. Sometimes, in fact, scepticism can be a form of kindness.

Alexander Korte is a gender clinician and researcher who has expressed concern for early transition as being a form of gay and lesbian eugenics (Korte 2008):

(Korte 2008)

Interview with Dr. Alexander Korte contains commentary from his involvement in the treatment of youth with gender dysphoria. He addresses the drastic rise in referrals, the changing demographics towards large increases of trans-identified females, possible comparisons to the MPD craze, and discusses the risk of pediatric transition to LGB youth who may not be given enough time to mature. Some comments from the interview below:

Regarding this, we see a marked increase in the number of biological girls, especially teenagers, in early or mid-adolescence.

What are the reasons for that?

One important reason, I think, could be that puberty requires much greater integration and adaptation skills of biological girls than it does of boys.  In this sense, we may possibly draw a parallel to eating disorders.  For anorexia, we assume a similar cause, namely that female adolescents are overwhelmed with the integration of sexuality at this age.  Some fail to rise to this challenge in puberty.  In particular they are overwhelmed with the underlying beauty and body image ideals, which they perceive as a powerful stressor and which put a lot of pressure on them.

You want kids to go through puberty.  Why?

Evidence shows that puberty-blocking treatments, which are presented by the advocates of such treatments as medically harmless, further a transsexual development and render it impossible for the patient to make experiences necessary for the formation of their identity including socio-sexual formation, i.e. relationships.  These are necessary experiences, also, for a homosexual coming out.  So in this I see the real problem.  That a puberty blocking treatment, to put it bluntly, could possibly be something like a homosexuality averting project.  Now this is obviously unethical for a medical treatment and nobody would wish for something like that…

I think what we are dealing with is a zeitgeist moment…

I have taken a clear stance. I am critical of the treatment [puberty blockers]. I think it needs to be reconsidered. The problem is the proportion of children taking puberty suppressing drugs who later decide to take cross sex hormones as a further step: the proportion of these children is close to 100%…

From a cultural-studies or sociological perspective view I would summarize: what’s driving this is modern society’s utopian belief in progress. This belief promises total satisfaction of needs…

Yeah, well, so whenever you talk about it as a doctor or a scientist, you have to expect criticism. This really only shows how ideologically mined the terrain is. And it is just this mostly ideological discussion that makes a fact-based and calmly conducted scientific examination of the subject impossible at times. That’s tragic, of course. We know this: ideology is the death of science just as populism is the death of democracy.

Similarities between Trans & Opposite Sex Controls

We are adding three studies on “third gender” individuals not previously referenced on the GHQ website. “Striving for Prestige in Samoa: A Comparison of Men, Women, and Fa’afafine” discusses effeminate males in the South Pacific and their attitudes about altruism:

ABSTRACT

In numerous non-Western cultures around the world, a small but meaningful proportion of individuals occupy alternative gender categories beyond the man/woman binary. A substantial body of past research has shown that feminine, same-sex attracted males in Samoa—a nonbinary gender known as fa’afafine—are more altruistic toward their nieces and nephews than are Samoan men and women. The present study examined the degree to which these kin-directed altruistic tendencies of fa’afafine are motivated by striving for prestige, and hence demonstrating value, within their family. Results showed that cisgender men and women do not differ in the degree to which they seek familial recognition of their altruistic behavior toward nieces and nephews. However, compared to men, fa’afafine sought significantly more acknowledgment of this altruism. These results illustrate one proximate cognitive mechanism for the elevated kin-directed altruism of fa’afafine and highlight the importance of the sociocultural context in which these motivations develop.

“Birth order and recalled childhood gender nonconformity in Samoan men and fa'afafine” discusses homosexuality and fraternal birth order. It seems to be a fact that a male is more likely to be homosexual the more older brothers he has.

"A Retrospective Study of Childhood Sex-Typed Behavior in Istmo Zapotec Men, Women, and Muxes" is a very relevant study to the GHQ website as it compares transgender effeminate males and homosexual males and finds the transgender individuals tend towards more female pattern behavior than homosexual males.

It would be extremely helpful if there could be a way to identify these children in distinct categories to understand how best to help them deal with being gender nonconforming in the gender-focused culture that exists everywhere. However, much of the information on the GHQ website points to a continuum between gnc gay/lesbian and trans that makes the issue of medically altering minors much more complicated and likely to risk false positives:

Abstract

Previous research has consistently demonstrated that both transgender and cisgender androphilic males (i.e., males attracted to adult males) display and recall higher levels of childhood female-typical behavior (CFTB) and lower levels of childhood male-typical behavior (CMTB) compared to gynephilic males (i.e., males attracted to adult females). In adulthood, the recalled CFTB and CMTB scores of cisgender androphilic males tend to be intermediate to those of opposite-sex-attracted men and women, whereas transgender androphilic males tend to score similar to women. These studies have been mostly conducted in Euro-American cultures. We examined recalled childhood sex-typed behavior (CSTB) among the Istmo Zapotec—a pre-Colombian culture in the Istmo region of Oaxaca, Mexico, where cisgender and transgender androphilic males are recognized as a third gender, known locally as muxes. The present study sought to determine whether Istmo Zapotec men (n = 180), cisgender muxe nguiiu (n = 63), transgender muxe gunaa (n = 120), and women (n = 138) differ with respect to recalled CFTB and CMTB. Our results indicate that men recalled significantly less CFTB and more CMTB than women. Cisgender muxesscored in between men and women. Transgender muxes scored similar to women. These findings provide further evidence that childhood sex-atypical behavior is a cross-culturally universal and normative developmental aspect of male androphilia, regardless of whether it manifests in the cisgender or transgender form. This is the first study to present quantitative data comparing the recalled CSTB of cisgender and transgender androphilic males from within the same non-Euro-American culture.

The Trans Youth Project has released several papers around their study that shows trans-identified children look the same on gendered behavior measures as the opposite sex they identify with. This finding is similar to the prior study on trans muxes who also report gendered behavior and interests that match up with female averages.

“Similarity in transgender and cisgender children’s gender development” provides charts that show responses to tests on gendered behavior look very similar to cross-sex controls as demonstrated by the graphic below:

Gülgöz (2019)

There is an observable pattern that children who are more extremely gender nonconforming are more likely to have gender dysphoria and are more likely to seek social transition. Parental and other outside influences are not shown to affect the child’s gender nonconforming (gnc) behavior. This reality isn’t something that we argue against on our site. Gender Health Query opposes any gender behavior policing of young people. But the evidence points to a continuum of gender dysphoria where there may be some children at risk for over-medicalization as children/tweens/teens as they exist between a place of insistent trans-identified youth and youth who may accept themself as a gnc, likely gay/lesbian person.

A statement from their paper is an example of the variations in behavior and identification:

“Predicting Early-Childhood Gender Transitions”

They also speak to the power of gender stereotypes and their effects on children whether trans-identified or not (called here “essentialist” thinking):

Gülgöz (2019)

“Gender essentialism in transgender and cisgender children”

While these charts may be used to argue for gender essentialism in trans-identified children, the authors state this isn’t proof their identities are sure to be static as they grow:

Gülgöz (2019)

Autogynephilia

The GHQ website covers the topic of autogynephilic MtF trans identity in heterosexual/bisexual males. They generally reveal their identity post-puberty and differ from the homosexual transexuals who present as very feminine as children. A graphic by clinical psychologist Dr. Morandina, shows the developmental pathways:

@Morangreenie, Australian Association of Cognitive Behaviour Therapy (AACBT) lecture

Autogynephilia (AGP) is a typology coined by Dr, Ray Blanchard. Quillette interviewed Dr. Ray Blanchard on the subject (What Is Autogynephilia? An Interview with Dr Ray Blanchard”):

This typology—which continues to attract a great deal of controversy—categorizes trans women (that is, natal males who identify as women) into two discrete groups.

The first group is composed of ‘androphilic’ (sometimes termed ‘homosexual’) trans women, who are exclusively sexually attracted to men and are markedly feminine in behaviour and appearance from a young age. They typically begin the process of medical transition before the age of 30.

The second group are motivated to transition as a result of what Blanchard termed ‘autogynephilia’: a sexual orientation defined by sexual arousal at the thought or image of oneself as a woman. Autogynephiles are typically sexually attracted to women, although they may also identify as asexual or bisexual. They are more likely to transition later in life and to have been conventionally masculine in presentation up until that point.

A quote from the article references bioethicist Alice Dreger who has written on the subject:

Although Blanchard’s typology is supported by a wide range of sexologists and other researchers, it is strongly rejected by most trans activists who dispute the existence of autogynephilia. The medical historian Alice Dreger, whose 2015 book Galileo’s Middle Finger included an account of the autogynephilia controversy, summarises the conflict:

“There’s a critical difference between autogynephilia and most other sexual orientations: Most other orientations aren’t erotically disrupted simply by being labeled. When you call a typical gay man homosexual, you’re not disturbing his sexual hopes and desires. By contrast, autogynephilia is perhaps best understood as a love that would really rather we didn’t speak its name. The ultimate eroticism of autogynephilia lies in the idea of really becoming or being a woman, not in being a natal male who desires to be a woman.”

The theory is also supported by psychologist Michael Bailey who discusses this in “The Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism.” Motivations for this are explained by MtF researcher, Anne Lawrence, who identifies as autogynephilic:

Autogynephilia is defined as a male's propensity to be sexually aroused by the thought of himself as a female. It is the paraphilia that is theorized to underlie transvestism and some forms of male-to-female (MtF) transsexualism.

Blanchard on autogynephilia and trans activism and the way this promotes denialism in the mental health profession:

Subsequently other strange and unexpected (to me) events befell my notion of autogynephilia. Modern trans activists reframed transsexualism/transgenderism as a political problem rather than a clinical problem. The flat denial that autogynephilia exists became a canon of modern trans activism, trans activism become a sub-department of the Social Justice Movement, and the Social Justice Movement became a primary combatant in the ongoing, pervasive Culture Wars…

Subsequently other strange and unexpected (to me) events befell my notion of autogynephilia. Modern trans activists reframed transsexualism/transgenderism as a political problem rather than a clinical problem. The flat denial that autogynephilia exists became a canon of modern trans activism, trans activism become a sub-department of the Social Justice Movement, and the Social Justice Movement became a primary combatant in the ongoing, pervasive Culture Wars.

The upshot is that most trans activists—and, in solidarity, their “allies”—deny that autogynephilia exists. Since most university psychologists, sociologists, and humanities professors are “allies,” the topic of autogynephilia may be omitted from Human Sexuality or Gender Studies courses for a generation. The other side in the Culture Wars (whatever one wishes to call that side) are prepared to recognize the existence of autogynephilia as soon as they learn of it, but they tend to hurl it as an insult at male-to-female trans who offend them. That, of course, is not what I intended when I coined the term 30 years ago…

At present, many heterosexual MTFs—in their own view, lesbian trans women—police online forums ceaselessly for any mention of autogynephilia.

Blanchard on the demographics of this fairly common paraphilia:

When I looked at the relative numbers of autogynephilic and androphilic gender-dysphoric males back in 1987, the autogynephilic cases were already a majority, approaching 60 percent. The proportion had reached 75 percent by 2010, and it might be even higher now.

Blanchard supports medical transition but not affirmation in all cases:

This depends on the intensity of the autogynephilia and, perhaps more importantly, on the severity of any gender dysphoria that arises in consequence of it. For mild or intermittent gender dysphoria, counselling or cognitive behavior therapy may be sufficient to help the patient through “flare-ups” of dysphoric feelings. This would be a logical choice of treatment if the patient has a marriage that he wants to maintain or a valued career that would inevitably suffer if he attempted to transition to the female role.

He does not believe trans activist agreements that females are also autogynephilic in their sexuality and thus “just like trans women”:

It seems a lot less feasible when one considers the various other ways in which some autogynephilic men symbolize themselves as women in their masturbation fantasies. Examples I have collected include: sexual fantasies of menstruation and masturbatory rituals that simulate menstruation; giving oneself an enema, while imagining the anus is a vagina and the enema is a vaginal douche; helping the maid clean the house; sitting in a girls’ class at school; knitting in the company of other women; and riding a girls’ bicycle. These examples argue that autogynephilic sexual fantasies have a fetishistic flavor that makes them qualitatively different from any superficially similar ideation in natal females.

There is also the telling phenomenon of autogynephiles who are involuntarily aroused by cross-dressing or cross-gender ideation, and who complain about difficulties changing into women’s attire without triggering erection or ejaculation. It seems likely that few natal women would give the analogous reports that they wish that they could put on their clothes without triggering vaginal lubrication or orgasm.

GHQ has discussed the rise in heterosexual females coming out as trans and identifying as gay men. Blanchard does not believe this is a reverse situation and refers to these individuals as autohomoerotics:

Do you think that natal females ever experience autoandrophilia [sexual arousal at the thought or image of oneself as male]?…

Until recent times, autohomoerotic female-to-male transsexuals were quite rare. The differences between autogynephilia in males and autohomoeroticism in females may seem subtle. Autogynephilic (male) gender dysphorics are attracted to the idea of having a woman’s body; autohomoerotic (female) gender dysphorics are attracted to the idea of participating in gay male sex. For autogynephiles, becoming a lesbian woman is a secondary goal—the logical consequence of being attracted to women and wanting to become a woman. For autohomoerotics, becoming a gay man appears to be the primary goal or very close to it.

There are also striking differences in developmental history. Many autogynephilic trans people report a period in their lives, usually during puberty, when they put on women’s undergarments (often “borrowed” from their mothers or sisters) and masturbated to orgasm. In contrast, self-reports of masturbating to orgasm in men’s underwear are missing in the histories of autohomoerotic females.

Due to the sexual nature of autogynephilia, there has been a strong activist backlash, involving very abusive behavior, that has been successful in eradicating this as a diagnosis among mental health professionals. The reasons for this are purely political. Due to the rise of the internet, there are AGPs who admit this this is the main motivation for heterosexual males who transition, and AGP narratives that fit this diagnosis can be found everywhere on trans social media sites. Some of them actually created an “Autogynephilia Awareness Day” for November 20th.

@AGPAwarenessDay

As a result of the charged identity politics around autogynephilia, the mental health community has not addressed the reality of this condition. Dr. Bailey believes this is dishonest and malpractice:

Examples of how some of these individuals seek validation for their autogynephilic drives from the lesbian community (which is causing a lot of conflicts within the LGBT population) can be found here.

Autism spectrum

Gender clinics have noted a consistent pattern of high rates of autism in people with gender dysphoria. We are linking a few studies here to understand this subject further.

“Is exposure to high levels of maternal intrauterine testosterone a causal factor common to male sex, autism, gender dysphoria, and non-right-handedness?”:

Abstract

We present evidence that male sex, autism, gender dysphoria and non-right-handedness share a common cause, viz. high levels of maternal first-trimester intrauterine testosterone. This provides an explanation for the (as yet unexplained) co-occurrences and co-morbidities between these conditions and pathologies…

“Initial Clinical Guidelines for Co-Occurring Autism Spectrum Disorder and Gender Dysphoria or Incongruence in Adolescents”:

Abstract

Evidence indicates an overrepresentation of youth with co-occurring autism spectrum disorders (ASD) and gender dysphoria (GD). The clinical assessment and treatment of adolescents with this co-occurrence is often complex, related to the developmental aspects of ASD. There are no guidelines for clinical care when ASD and GD co-occur; however, there are clinicians and researchers experienced in this co-occurrence. This study develops initial clinical consensus guidelines for the assessment and care of adolescents with co-occurring ASD and GD, from the best clinical practices of current experts in the field…

The paper “Perspectives of Mothers of Transgender and Gender-Nonconforming Children With Autism Spectrum Disorder” discusses parents reactions to having a child with GD and ASD:

This study represents findings from interviews at two time points with three mothers of transgender and gender-nonconforming (TGNC) children (ages 8 to 12 years at T1) with autism spectrum disorder (ASD). Of interest was the mothers’ experiences of raising a TGNC child with ASD, and whether/how the children’s autism played a role in their understandings of their children’s gender identities and expressions. The mothers’ fear of a transphobic/cisnormative society and wondering about whether their children’s ASD influenced or caused their children’s gender variance were barriers to fully embracing their children’s gender nonconformity. Unclear causes of children’s social/emotional difficulties and lack of adequate resources and support were identified challenges. Positive interventions and resources were also discussed. Recommendations for clinicians and other professionals who serve TGNC youth with autism and their families are presented.

Like gender dysphoria, autism has become politicized with social justice and identity politics rhetoric. From Aeon:

Worryingly, this trend of romanticising autism has extended to other conditions that can be severe, debilitating, and life-threatening. There are now groups of self-advocates who celebrate depression and schizophrenia. This could also be related to the growth of pro-anorexia websites, as well as the more recent emergence of ‘addiction pride’.

The idea that autism is ‘a variation of normal’ is at odds with scientific understanding of the condition. The general consensus among neuroscientists is that autism has neurodevelopmental origins, with recent research showing that it is associated with abnormalities in brain cell numbers and white-matter structure, and defects in synaptic pruning, the process by which unwanted synaptic connections are eliminated.

There are some parallels to autism “social justice” and the demand society uses third gender pronouns for people with gender issues. And they blame higher rates of mental health problems non-binaries have on “bigotry.”

However, neurodiversity advocates reject the medical model of autism, in favour of an as-yet undetermined social model that blames the problems faced by autistic people on systematic ‘ableist’ discrimination. Some of their reasons for doing so are valid. Historically, autistic people have existed on the margins of society, and have been victimised by the medical-industrial complex that aimed to coercively eliminate them and others considered to be disabled. For example, Asperger was complicit in the Nazi regime’s euthanasia programme for disabled children…

Neurodiversity advocates still label those who express a desire for treatment or cure as Nazis and eugenicists. ‘When we fight for autism rights, we are fighting for our continued existence,’ wrote the self-advocate Jackson Connors in the People’s World newspaper this June. ‘Against our dehumanisation. Against a “cure”, which is a dogwhistle for ableist eugenics. And against the systems that push so many of us to poverty and suicide.’

In their zealous pursuit of autistic rights, some advocates have become authoritarian and militant, harassing and bullying anyone who dares to portray autism negatively, or expresses a desire for a treatment or cure. This extends to autism researchers in academia and the pharmaceutical industry, and also to the parents of severely autistic children. One widely used treatment is Applied Behavioural Analysis (ABA), which involves intensive one-on-one therapy sessions aimed to develop social skills. However, neurodiversity advocates consider ABA to be cruel and unethical, and campaign for withdrawal of government funding for the treatment

Yale has published a review of autism and gender dysphoria issues in 2015 we are adding here (“Gender identity and autism spectrum disorders”). A picture emergers that ASD youth take longer to mature which is why some parents and health professionals are concerned about pediatric transition and autism.

A Kinder Culture Towards Gender Nonconforming Youth?

“New intervention may help ease young children's biases against gender-nonconforming peers” is a study on the environmental and cultural effects of the way children see gender and other gender nonconforming children.

The study verifies the poor treatment of gender nonconforming children by other children:

The study found that the children as young as 4-years old gave less positive appraisals and shared less generously with peers who did not conform to stereotypical expressions of gender. This finding was stronger when the children watching the vignettes were older or the children in the videos were boys.

The study shows that children show more positive attitudes towards gnc youth if shared characteristics are emphasized:

"Our study suggests that highlighting positive attributes of individuals and qualities that gender-conforming and nonconforming children share more broadly--without highlighting whether they are conforming or nonconforming--could be helpful," according to Doug VanderLaan, assistant professor of psychology at the University of Toronto Mississauga and co-corresponding author of the study. "For example, teachers could create opportunities for children to learn about how each person is special as an individual and ways that they are potentially similar."

The authors of the study write:

“Our study breaks new ground by showing that 8- and 9-year-olds can be influenced to be more positive toward their gender-nonconforming peers," notes Ivy Wong, assistant professor of psychology and gender development at the Chinese University of Hong Kong and the University of Hong Kong, who led the study. "The findings can help develop strategies to reduce bias against gender nonconformity; a bias which appears to place some children at risk of peer rejection."

References:

Costandi, M. (2019, September 12). Against neurodiversity. Aeon. Retrieved from https://aeon.co/essays/why-the-neurodiversity-movement-has-become-harmful

Dreger, A. (2006, May 13). The Blog I Write in Fear. Retrieved from http://alicedreger.com/in_fear

Ehrensaft, D. (2019). Preschool child sex abuse: The aftermath of the Presidio case. American Journal of Orthopsychiatry, 62(2), 234–244. doi.org/10.1037/h0079332

EurekaAlert. (2109, October 24). New intervention may help ease young children's biases against gender-nonconforming peers. Retrieved from https://www.eurekalert.org/pub_releases/2019-10/sfri-nim101719.php

Gülgöz, S., DeMeules, M., Gelman, S.A., Olson, K. (2019). Gender essentialism in transgender and cisgender children. Plos One. doi.org/10.1371/journal.pone.0224321

Gülgöz, S., Glazier, J., Enright, E., Alonso, D., Durwood, L., Fast, A.A., Lowe, R., J. Chonghui, Heer, J., Martin, C.L., Olson, K. (2019). Similarity in transgender and cisgender children’s gender development. PNAS. doi.org/10.1073/pnas.1909367116

Interview with Dr. Alexander Korte. (2019) Retrieved from http://gdworkinggroup.org/2019/11/15/interview-with-dr-alexander-korte/

James W.H., Grech, V. (2019) Is exposure to high levels of maternal intrauterine testosterone a causal factor common to male sex, autism, gender dysphoria, and non-right-handedness? Early Human Development. doi.org/10.1016/j.earlhumdev.2019.104872

Jiménez, F. R.G., Court, L., Vasey, P.L. (2019). A Retrospective Study of Childhood Sex-Typed Behavior in Istmo Zapotec Men, Women, and Muxes. Archives of Sexual Behavior. DOI: 10.1007/s10508-019-01544-6

Kuvalanka, K.A., Mahan, D.J., McGuire, J.K., Hoffman, T.K. (2018) Perspectives of Mothers of Transgender and Gender-Nonconforming Children With Autism Spectrum Disorder. Journal of Homosexuality 65(9), 1167-1189. doi.org/10.1080/00918369.2017.1406221

Korte, A. (2008). Gender Identity Disorders in Childhood and Adolescence – Currently Debated Concepts and Treatment Strategies. Deutsches Aerzteblatt Online. doi:10.3238/arztebl.2009.0318b

Perry, L. (2019, November 6). What Is Autogynephilia? An Interview with Dr Ray Blanchard.” Quillette. Retreived from https://quillette.com/2019/11/06/what-is-autogynephilia-an-interview-with-dr-ray-blanchard/

Perry, L. (2019, October 23). Culture-Bound Syndromes: Satanic Panics, Multiple Personality Disorder & ROGD. Aero. Retrieved from https://areomagazine.com/2019/10/23/culture-bound-syndromes-satanic-panics-multiple-personality-disorder-rogd/

Rae, J.R., Gülgöz, S., Durwood, L., DeMeules, M., Lowe, R., Lindquist, G. Olson, K.R. (2019) Predicting Early-Childhood Gender Transitions. Psychological Sciences. doi.org/10.1177/0956797619830649

Semenyna, S.W., VanderLaan D.P., Vasey, P.L. (2017). “Birth order and recalled childhood gender nonconformity in Samoan men and fa'afafine”. Developmental Psychobiology 59(3), 338-347 doi.org/10.1002/dev.21498

Semenyna, S.W., Vasey, P.L. (2018). Striving for Prestige in Samoa: A Comparison of Men, Women, and Fa’afafine. Journal of Homosexuality 66(11). 1535-1545. doi.org/10.1080/00918369.2018.1503461

Strang, J.F., Meagher, H., Kenworthy L., de Vries, A.L.C., Menvielle, E., Leibowitz, S., Janssen, A., Cohen-Kettenis, P., Shumer D.E., Edwards-Leeper L., Pleak R.R., Spack N., Karasic D.H., Schreier, H., Balleur, A., Tishelman, A., Ehrensaft, D., Rodnan, L., Kuschner, E.S., Mandel, F., Caretto, A., Lewis H.C., Anthony, L.G. (2018). Initial Clinical Guidelines for Co-Occurring Autism Spectrum Disorder and Gender Dysphoria or Incongruence in Adolescents. Journal of Clinical Child and Adolescent Psychology 47(1).105-115. doi: 10.1080/15374416.2016.1228462.

van Schalkwyk, G.I., Klingensmith K, Volkmar, F.R. (2019). Gender identity and autism spectrum disorders. Yale Journal of Biology and Medicine 88(1), 81-3.

New Research Doesn't Find A Specific "Gay Gene"

News

This BBC news story about a search for a “gay gene” is being tagged to our section on nature versus nurture research on trans and homo/bisexual identity.

A genetic analysis of almost half a million people has concluded there is no single "gay gene".

The study, published in Science, used data from the UK Biobank and 23andMe, and found some genetic variants associated with same-sex relationships.

But genetic factors accounted for, at most, 25% of same-sex behaviour.

Update 08/31/19: Related article, “Genetics may explain up to 25% of same-sex behavior, giant analysis reveals”

References:

BBC. (2019, August 29). No single gene associated with being gay. Retrieved from https://www.bbc.com/news/health-49484490

Kaiser, J. (2019, August, 29). Genetics may explain up to 25% of same-sex behavior, giant analysis reveals. Science. Retrieved from https://www.sciencemag.org/news/2019/08/genetics-may-explain-25-same-sex-behavior-giant-analysis-reveals

A Review Study Shows Higher Rates of Child Abuse Among Gender Nonconforming Children

News

A study that reviewed other studies regarding trans and gender nonconforming individuals reveals a pattern that they have higher rates of being child abuse victims. The abuse is also associated with other negative mental health outcomes in adulthood.

RESULTS

All studies were cross sectional, exploratory/descriptive. Rates of child abuse were high, with up to 100% of transgender males reporting childhood sexual abuse in one study. In four studies that measured childhood gender nonconformity (CGNC), children who exhibited CGNC were more likely to be abused. In the eight studies that investigated the association of childhood abuse among transgender and gender nonconforming people, it was associated with negative adult outcomes, such as sex without a condom, self‐harm, past year drug use, post‐traumatic stress disorder (PTSD) symptoms, and suicide attempts.

References:

Tobin, V., Demaney, K.R. (2019.) Child abuse victimization among transgender and gender nonconforming people: A systematic review. Perspectives in Psychiatric Care. DOI: 10.1111/ppc.12398

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 New Brain Imaging Study Comparing Trans Women and Cross-Sex Controls Show Differences Based on Biological Sex

News

A new study called “Sex Matters: A Multivariate Pattern Analysis of Sex- and Gender-Related Neuroanatomical Differences in Cis- and Transgender Individuals Using Structural Magnetic Resonance Imaging” has been published in the journal Cerebral Cortex.

There are some relevant quotes about possible biological reasons for trans identity. Trans peoples brains may share some similarities to cross-sex controls:

A better understanding of neurobiological sex differences in terms of prevalence discrepancies, differing disease trajectories and outcomes in diverse psychiatric conditions is indispensable (Cahill 2006). Research dealing with gender issues in neuroscience claims that our brains are individual mosaics of female and male characteristics, thereby rejecting the simplistic idea of a “female” or “male” brain (Maney 2014; Joel et al. 2015). In light of this general rethinking, our findings support previously published evidence demonstrating that the brain structure of transgender people partially converges on an assumed sex continuum, although we cannot conclude from our findings that it resembles the morphology of the respective gender identity (Swaab 2007; Savic et al. 2010).

This study, as well as other brain imaging studies, still shows that there are differences between trans peoples’ brains and cross-sex controls:

Generally, we can conclude from our analysis that sex has a major effect on GM irrespective of the self-perception of being a woman or a man.

GHQ covers most of the research around the biological causes of both transgenderism and homo/bisexuality and possible environmental influences. Our position is that brain imaging studies should also use gender nonconforming homosexual controls, as well as heterosexual cross-sex controls, to better understand the differences between trans and gay/lesbian people, as this is the main contention in the issue of transitioning children. Some children grow out of gender dysphoria and are more likely to be LGB adults.

References:

Baldinger-Melich, P., Castro, M., Seiger, R., Ruef, A., Dwyer, D., Kranz, G., Manfred, K., Kambeitz, J., Kaufmann, U., Windischberger, C., Kasper, S., Falkai, P., Lanzenberger, R., Koutsouleris, N. (2019). Sex Matters: A Multivariate Pattern Analysis of Sex- and Gender-Related Neuroanatomical Differences in Cis- and Transgender Individuals Using Structural Magnetic Resonance Imaging, Cerebral Cortex, , bhz170. doi.org/10.1093/cercor/bhz170

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.

GHQ Letter Sent to USC Neuroscientist Who Wants to Study Transgender Brains

News Commentary

Jonathan Vanhoecke, who has an MA in neuroscience, wants to use neuroimaging to study the brains of transgender people and compile data in ENIGMA (a global research network based at USC).

The article, Researcher explores links between transgender brain and gender identity, explains:

Understanding how their brains develop and change as transgender people grow up could help doctors and other health professionals provide better treatment and support.

There is a lot of evidence showing there is a grey area between gender nonconforming gay and lesbian people and trans people. This is demonstrated in research statistics showing desistance rates from childhood gender dysphoria and its association with adult homosexuality and Increasingly bisexuality. It is also apparent in the increasing numbers of accounts of desisted and detransitioned (underwent medical procedures) lesbian and bisexual females. If neuroimaging could be used to tell a “true trans child/teen” from a minor who could outgrow gender dysphoria, this would be a useful tool in how to best support the young person. It is unlikely to be this simple. There is a lot of evidence on the GHQ website to support the argument that environment and other factors influence gender dysphoria and trans-identification.

The article mentions that there is a mix of information provided by the previous studies:

So far, results from the few existing studies are inconclusive, Vanhoecke said. Some evidence suggests differences in gender identity could be linked to ways the brain develops in childhood and adolescence, and that the observed patterns correspond to gender identity. Other studies have indicated that neural patterns generally match the sex a person is assigned at birth. Yet other studies found evidence that doesn’t seem to support either of these, but rather that there are unique neural patterns in transgender people.

Topic 10 thoroughly covers the research that is available on biological and environmental causes of both transgenderism and homosexuality, and in some cases, the causes may be similar.

The article discusses a brain region that may be involved in gender dysphoria:

Vanhoecke aims to study systems of the brain, including a part of the brain’s white matter that might be involved in differences between sex assigned at birth and gender identity. It’s called the inferior fronto-occipital fasciculus, a bundle of white brain fibers that runs along the lower portion of the brain between the occipital and frontal lobes. Analyzing its structure in greater detail might offer clues about its role in gender identity and guide future studies, he said.

Interestingly, it is the inferior fronto-occipital fasciculus that may be involved in anorexia nervosa, bulimia nervosa, and body dysmorphic disorder. Medical transition used for gender dysphoria appears to be more effective than plastic surgery is for BDD.

One of the goals of this organization is to put pressure on researchers to admit that there is a blurry line between trans and gay and to keep this in mind conducting research:

15) Insist that brain research studies trying to determine the causes of transsexualism, use very gender nonconforming gays and lesbians as controls, before they reach their conclusions. There are likely spectrum effects in the causes of homosexuality and transgenderism. Heterosexuals are not the best controls to determine if transgenderism is completely innate. There is much information that shows that for some individuals it isn’t, and that it’s influenced by culture. In relation to the medical transition of minors, and it’s safety to desisters, comparing gays/lesbians with trans people is more relevant.

Below is a letter written in response to Vanhoecke and the other researchers listed in this article around this subject:

To Mr. Vanhoecke, Ms. Savic, Mr. Thompson,and Mr. Feusner,

This letter is about the article Researcher explores links between transgender brain and gender identityon the USC’s news website about using neuroimaging to study transgender people. 

Gender Health Query is an LGBT organization that was formed as a result of the increasing numbers of LGBT people who have major concerns about the number of minors who are being permanently altered by medical treatments for gender dysphoria. This includes concerns about the hormone blocker protocol, which can begin as young as 10 years old, as well as double mastectomy and vaginoplasty surgeries under the age of 18. 

There are concerns about this for two main reasons. The first is that these medical techniques are very invasive and may cause bone weakening, permanent sexual dysfunction, sterility, possible cognitive effects, and a very large increase in circulatory health risks. The second main reason for concern by our group is that all research, as well as more recently observed examples, shows an association with youth gender dysphoria and adult lesbian, gay, and bisexual identity. And indeed, there appears to be more transition regret, particularly among lesbian and bisexual females, who transitioned before they were cognitively mature (full maturity is not reached until age 25). 

So the worry is, particularly in the gay and lesbian community, that borderline gay, lesbian, and bisexual youth are going to be over-medicalized with the current enthusiasm to socially and medically transition children, teens, and young adults. These fears seem warranted given that five gender clinician professionals in the United Kingdom have quit because of ethics concerns. They cite internalized, as well as parental homophobiaas reasons they believe early medical treatments risk pre-gay and lesbian youth. These fears also seem warranted due to reports from parents, or the young people themselves, that a trans-identification lasted several years in the tweens and teens before desistance. This is long enough to receive an official DSM diagnosis and receive testosterone and doublemastectomy. 

Our website documents many examples of factorsbeyond innate biological gender identity that appear to influence gender dysphoria. These include homophobic bullying, parental instability, mental health issues, and social contagion. There are people who wish to be the opposite sex from a young age and who will choose transition. But it seems unlikely that a brain scan will be enough to determine which minors are “truly trans,” as it appears there is more of a continuum between homosexual and trans, rather than a clear line. Dr. Ray Blanchard’s work on the “older brother effect”on both trans and homosexual identity supportsthis idea.

For these reasons, it seems that using very gender nonconforminghomosexual controls, as well as opposite sexcontrols, in brain imaging studies would provide interesting comparisons. Several studies of homosexuals’ brains also show cross-sex similarities. One of the goals of our organization is to notice when researchers seem uninterested in the blurred line between trans and gay because it worries so many of us when it comes to transitioning children. 

And a brain study will not necessarily be able to answer what causes the differences in areas such as the inferior fronto-occipital fasciculus. This area may be affected in body dysmorphias as well. Could more cultural acceptance mitigate any bodyanxiety in people who are gender outliers? What did the brains of the desisted teens look like during and after their trans-identification lifted? The cultural questions are still interesting.

Another relevant factor in brain imaging studies not mentioned in the article is the difference between males who transition who are attracted to men versus males who are attracted to women. Dr. Ray Blanchard, the researcher mentioned above, is an expert in adult gender dysphoria. He categorized the two groups as homosexual transexuals (HSTS) and autogynephilic (AGP) males. The de-emphasis of this categorization in research is all political, as Blanchard describes AGP as a type of paraphilia, rather than a brain feminization. Despite the fact that some trans activists find this offensive, there is no scientific reason not to pursue this theory and one brain imaging study has already indicated that HSTS and AGP are two different phenomena.

Sexologist Dr. James Cantor:

“[T]he brains of both homosexual and heterosexual male-to-female transsexuals probably differ from the brains of typical heterosexual men, but in different ways. In homosexual male-to-female transsexuals, the difference does involve sex-dimorphic structures, and the nature of the difference is a shift in the female-typical direction. If there is any neuroanatomic intersexuality, it is in the homosexual group. In heterosexual male-to-female transsexuals, the difference may not involve sex-dimorphic structures at all, and the nature of the structural difference is not necessarily along the male–female dimension. (p. 437”)

Many parents are starting to see gender nonconforming children as transgender. This is facilitating large numbers of children being socially transitioned and given hormone blockers before they have experienced any puberty (the time when gnc gay and trans identities often separate out). Some of these children may not be adults who would definitely transition. It would be irrelevant if not for children being put on medical pathways, with serious health consequences, at younger and younger ages. The efforts in brain research should also focus on protecting these grey area children from over-medicalization, not just trans medical treatment. 

Thank you for your time.

References:

Buchanan, B.G., Rossell, S.L., Maller J.J., Toh W.L., Brennan S., Castle, D.J. (2013). Brain connectivity in body dysmorphic disorder compared with controls: a diffusion tensor imaging study. Psychology Medicine. 43(12), 2513-2521. doi:10.1017/S0033291713000421

Cantor, J. M. (2011). New MRI Studies Support the Blanchard Typology of Male-to-Female Transsexualism. Archives of Sexual Behavior, 40(5), 863-864. doi:10.1007/s10508-011-9805-6

Cornell University. (2018, March 26). What does the scholarly research say about the effect of gender transition on transgender well-being? Retrieved from https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/

Dreger, A. (n.d.). Answers to Some Questions about Autogynephilia. Retrieved from http://alicedreger.com/autogyn

Gaudio, S., Carducci, F., Piervincenzi, C., Olivo G., Schiöth H.B. (2019). Altered thalamo–cortical and occipital–parietal– temporal–frontal white matter connections in patients with anorexia and bulimia nervosa: a systematic review of diffusion tensor imaging studies. Psychiatry Neuroscience, 44(3),1-16. doi:10.1503/jpn.180121

Higgins, S., Wysong, A. (2018). Cosmetic Surgery and Body Dysmorphic Disorder – An Update. International Journal of Women's Dermatology, 4(1), 43–48. doi:10.1016/j.ijwd.2017.09.007

Lindberg, E. (2019, July 15). Researcher explores links between transgender brain and gender identity. USC News. Retrieved from https://news.usc.edu/158899/transgender-research-usc-brain-gender-identity/

Travisa, K. Golden, N. Heidi, Feldman, H., Solomon M., Nguyen J., Mezer, A., Yeatman, Dougherty, R. (2015). Abnormal white matter properties in adolescent girls with anorexia nervosa. NeuroImage: Clinical, 9, 648-659. doi:10.1016/j.nicl.2015.10.008

Vanderlaan, D. P., Blanchard, R., Zucker, K. J., Massuda, R., Fontanari, A. M., Borba, A. O., … Lobato, M. I. (2016). Birth order and androphillic mate-to-female transsexualism in Brazil. Journal of Biosocial Science, 49(4), 527-535. doi:10.1017/s0021932016000584

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.

Another Study Confirms a Link Between Autism & Gender Dysphoria

News

Studies and gender clinic observations have noted that autism spectrum individuals are greatly over represented in youth seeking treatment for gender dysphoria. More research is needed in this area. GHQ covers the GD/autism link here and here and here.

EurekaAlert has reported on a new study from Anglia Ruskin University, (Stagg, 2019), that confirms this pattern:

It found that 14% of the transgender and non-binary group had a diagnosis of autism, while a further 28% of this group reached the cut off point for an autism diagnosis, suggesting a high number of potentially undiagnosed individuals.

There is an increase of trans-identified females and many are on the autism spectrum:

These figures were primarily driven by high scoring amongst those whose assigned gender was female at birth, supporting recent evidence that there is a large population of undiagnosed women with an autism spectrum disorder.

The study highlights some personality traits of autism spectrum individuals that may influence how they relate to their gender:

The authors also found higher levels of systematising (a tendency to analyse, control and use rule-based systems) and lower levels of empathy amongst the transgender and non-binary group, characteristics often found in individuals with an autism spectrum disorder.

And:

"People with autism are also more likely to seek unequivocal answers to the complex issues surrounding gender identity. Our study suggests it is important that gender identity clinics screen patients for autism spectrum disorders and adapt their consultation process and therapy accordingly."

References:

Study finds transgender, non-binary autism link. (2019, July 16). EurekaAlert. Retrieved from https://eurekalert.org/pub_releases/2019-07/aru-sft071619.php

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.

An Article in The Week on Radical Gender Ideolgy: An Interesting Read

News Commentary

An article in The Week “Liberals' astonishingly radical shift on gender,” by Damon Linker, addresses the rapid adoption of radical ideologies about sex and gender by large swaths of society. This includes the view that sex is identity based (not biology based), that gender is a spectrum, and that other people should be recruited into validating someone’s chosen 3rd gender pronouns be instituting policies that force people to participate in it.

This article is being tagged to our section on “Cultural Ripple Effects.” There is a discussion in that topic about how some people think, even within the LGBT population, that there are negative cultural impacts of these ideas, namely a glorification of body dismorphia, sexual and gender confusion, and an unhealthy level of focus on identity rather than personal character.

Another article relating to these culture issues appeared in the London Times called “Lesbians face a fight for their very existence.” Janice Turner writes about how these issues effect lesbians the most, from the influences of gender ideology, to the large increase of same-sex attracted females transitioning.

References:

Linker, D. (2019, July 12). Liberals' astonishingly radical shift on gender. The Week. Retrieved from https://theweek.com/articles/852090/liberals-astonishingly-radical-shift-gender

Turner, J. (2019, July 13). Lesbians face a fight for their very existence. The Times [London]. Retrieved from https://www.thetimes.co.uk/article/lesbians-face-a-fight-for-their-very-existence-v97mswc0p

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.

New Study Released on Biological Factors Regarding Male Homosexuality

News

A new study was released describing several different biomarkers for male homosexuality and their relationship to gender nonconformity. This is relevant to discussions on this website because there appears to be a blurry line between trans MtFs and some gender conforming gay men. And in youth there is an association with childhood gender dysphoria and adult homosexuality. If there where some way to isolate a “true trans” child from a pre-gay child, the child/teen transition debate would be less controversial.

More on the subject of nature versus nurture on the GHQ site can be found here.

“Evidence for distinct biodevelopmental influences on male sexual orientation”:

Swift-Gallant et al. 2019

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 Psychology Professor Believes Children Are Susceptible to Being Influenced by Gender Ideology

News Commentary

A recent College Fix article discusses the issue of nature versus nurture in gender identity and children.

In a recent talk and subsequent Internet post, a professor of psychology disputed the idea that children can honestly determine their “gender identity”—whether or not they are a boy or a girl—at their earliest ages.

Professor Katie Alcock’s original post on Medium is called “Young children, reality, sex and gender.”

The current popular narrative about childhood and teen gender identity is that dysphoric children are “trapped in the wrong body.” Gender dysphoria is due to a body defect, not a mental health issue. This is the viewpoint behind the recent move to add the term “gender incongruence” to the forthcoming edition of ICD (ICD-11) into a new chapter termed “Conditions Related to Sexual Health.” In this way, a trans child (and adult) will be viewed as simply having a physical birth defect that needs medical correction.

But there is evidence of environment influences on how children see other’s gender and their own gender beyond the “pink brain/blue brain” narrative. Topic 10 reviews “nature versus nurture” research on gender dysphoria and homosexuality. Factors such as family situation, homophobia, and mental health issues influence gender dysphoria. And Dr. Alcock believes that children’s perceptions of their own gender may be influenced by the gender expectations around them:

So researchers are clear that we are talking about children’s knowledge of sex, and that this can’t change. A nice quote from a 2003 paper:

“Categorical sex is an essential, immutable attribute of people that is maintained (by self and others) independent of changes in physical appearance (e.g., in hairstyle, clothes, or make-up) and of changes in behaviour (e.g., cross-sex play behaviour or homosexuality).” (from Trautner et al., 2003, in the International Journal of Behavioral Development)

Nevertheless, it takes children some time to work out both whether they themselves are a girl or a boy, and that both they and others cannot change sex. Working out which they are themselves happens earlier, and is based in all the studies that have been done on physical appearance and stereotypes. 

She then proceeds to show several examples of this. Children see gender in terms of stereotypical haircuts and dress. This information explains the reasons why people are concerned, including LGB people, parents, and even gender dysphoria professionals, that grey area youth, more likely to be LGB when they get older, may be harmed by having their gender confusion validated.

The reasons for stereotyping are rooted in the need for humans, including children, to be able to make generalizations at times in life (even if they are problematic sometimes):

Making generalisations is a very useful skill for a baby or child — if they couldn’t make generalisations, they would never be able to work out that a new cat they saw was in fact a cat, or a new apple was just as good to eat as the last one, or a new car is likely also to go places. Children can work out at a very young age that there are men and women, boys and girls, in the world — it’s probably quite useful for them to work this out in the general scheme of things².
So when they see all the girls at nursery wearing pink and having long hair, well, that’s what girls do! And they also realise, from what people are saying, and from how their parents dress them, what toys they are given, and what toys other children who look like them (same clothes, same hair) what they are supposed to like and do based on what sex they are.³

And:

Children know what they like. When society and the world tells them that the things they like are those that boys like — but they have been told in words that they are a girl — well, that’s easy. They already know that having short hair makes you into a boy. They know that playing with cars makes you into a boy. So it’s easy! Boy all the way. And their version of the world, at their age, means that changing sex is totally possible.

Dr. Alcock’s comments emphasis nurture. In contrast, the narrative promoted by the Trans Youth Project is generally “innate gender identity.” The Trans Youth Project studies are being used to validate early social transitions of thousands of children, to put thousands more on hormone blockers, and to support arguments for earlier and earlier medical interventions (whether this is the researchers’ intentions or not). In this article, head psychologist Kristina Olson doesn’t mention the possibility of desistance or its association with adult LGB identity. In this article, she calls concerns about the psychological impact of social transition “alarmist.” And here, the Trans Youth Project promotes the view that trans children “know who they are” when they both say they are trans and match cross-sex interests of controls. Olson’s view is that desistance was over stated in previous research. Her cohort’s declarations of “I am a girl” (versus wanting to be a girl), as well as a match in cross-sex interests, indicates a testable, innate trans identity.

Alcock indicates children may be influenced to understand their gender due to being drawn to cross-sex interests and style and opposite sex playmates. This is precisely Debra Soh’s criticism of the gender dysphoria affirmative model as stated in “The Unspoken Homophobia Propelling the Transgender Movement in Children” and elsewhere. It’s also getting difficult to argue that culture doesn’t affect gender dysphoria in youth as the demographics between younger and older people are so different, with now an increase in females transitioning.

A review of the trans child narrative and how it is heavily promoted through gender stereotypes can be found here and here. All of the educational graphics involve short hair versus long hair and GI Joe and Barbie type of imagery.

Children who will grow up to be trans adults are drawn to stereotypical cross-sex interests. But so are pre-gay/lesbian/bi children.

Autism spectrum individuals may also be susceptible to seeing their cross-sex interests as being indicative of their “innate” gender identity, as rigid and obsessive thinking may be part of the symptoms (here and here).

These are issues as medical transition starts as young as nine years old now in the United States.

GHQ seeks to learn the influence of gender ideology on pre-same-sex attracted and other gender nonconforming youth to ensure those youth are not over-medicalized as minors. Since detransitioned young people are often LGB, this is a population that deserves study and protection, as do trans youth. Determining all of these influences is necessary in determining best pathways to support dysphoric youth.

References

Alcock, K. (2019, May 29). Young children, reality, sex and gender. Medium. Retrieved from https://medium.com/@katieja/young-children-reality-sex-and-gender-3421f4f165f1

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.